Provider Demographics
NPI:1174858120
Name:ADULT DAY HEALTH CARE PROGRAM
Entity Type:Organization
Organization Name:ADULT DAY HEALTH CARE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-365-3501
Mailing Address - Street 1:16 GUION PL
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5502
Mailing Address - Country:US
Mailing Address - Phone:914-365-3501
Mailing Address - Fax:914-632-4938
Practice Address - Street 1:16 GUION PL
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5502
Practice Address - Country:US
Practice Address - Phone:914-365-3501
Practice Address - Fax:914-632-4938
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HELEN AND MICHAEL SCHAFFER EXTENDED CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5904314N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01719382Medicaid