Provider Demographics
NPI:1275946873
Name:MOFFAT GARDENS ALP, INC.
Entity Type:Organization
Organization Name:MOFFAT GARDENS ALP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / C.E.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-928-3501
Mailing Address - Street 1:22 MOFFAT ST.
Mailing Address - Street 2:ADMINISTRATIVE SUITE FIRST FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207
Mailing Address - Country:US
Mailing Address - Phone:718-676-6130
Mailing Address - Fax:866-734-2751
Practice Address - Street 1:22 MOFFAT ST.
Practice Address - Street 2:ADMINISTRATIVE SUITE FIRST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207
Practice Address - Country:US
Practice Address - Phone:718-676-6130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331-S-009310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03356645Medicaid