Provider Demographics
NPI:1215006960
Name:EPISCOPAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:EPISCOPAL HEALTH SERVICES INC
Other - Org Name:BISHOP WALDO MCLEAN NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHERIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALATHRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-349-5227
Mailing Address - Street 1:1711 BROOKHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4406
Mailing Address - Country:US
Mailing Address - Phone:718-869-7641
Mailing Address - Fax:718-869-8507
Practice Address - Street 1:1711 BROOKHAVEN AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4406
Practice Address - Country:US
Practice Address - Phone:718-869-7641
Practice Address - Fax:718-869-8507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003356N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00337242Medicaid
NY335682Medicare Oscar/Certification