Provider Demographics
NPI:1285633354
Name:MIRIAM OSBORN MEMORIAL HOME ASSOCIATION
Entity Type:Organization
Organization Name:MIRIAM OSBORN MEMORIAL HOME ASSOCIATION
Other - Org Name:THE OSBORN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:914-925-8208
Mailing Address - Street 1:101 THEALL RD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-1406
Mailing Address - Country:US
Mailing Address - Phone:914-925-8350
Mailing Address - Fax:914-925-8294
Practice Address - Street 1:101 THEALL RD
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-1406
Practice Address - Country:US
Practice Address - Phone:914-925-8350
Practice Address - Fax:914-925-8294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5954300N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY335797Medicare Oscar/Certification