Provider Demographics
NPI:1144245978
Name:ISABELLA GERIATRIC CENTER, INC.
Entity Type:Organization
Organization Name:ISABELLA GERIATRIC CENTER, INC.
Other - Org Name:ISABELLA HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KATOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-342-9300
Mailing Address - Street 1:515 AUDUBON AVE
Mailing Address - Street 2:ATTN: FINANCE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3403
Mailing Address - Country:US
Mailing Address - Phone:212-342-9309
Mailing Address - Fax:212-781-6303
Practice Address - Street 1:5073 BROADWAY
Practice Address - Street 2:ATTN: HOME CARE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1131
Practice Address - Country:US
Practice Address - Phone:212-342-9500
Practice Address - Fax:212-342-9876
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISABELLA GERIATRIC CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-13
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002905L251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01115122Medicaid
337263Medicare ID - Type Unspecified