Provider Demographics
NPI:1215004353
Name:CATHOLIC GUARDIAN SOCIETY & HOME BUREAU
Entity Type:Organization
Organization Name:CATHOLIC GUARDIAN SOCIETY & HOME BUREAU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-371-1000
Mailing Address - Street 1:1011 1ST AVE FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4112
Mailing Address - Country:US
Mailing Address - Phone:212-371-1000
Mailing Address - Fax:212-371-1512
Practice Address - Street 1:107 PAYSON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-2763
Practice Address - Country:US
Practice Address - Phone:212-567-2847
Practice Address - Fax:212-567-5591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00356905Medicaid