Provider Demographics
NPI:1316042120
Name:TENBC INC
Entity Type:Organization
Organization Name:TENBC INC
Other - Org Name:TEN BROECK COMMONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAGUERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-336-6666
Mailing Address - Street 1:ONE COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE KATRINE
Mailing Address - State:NY
Mailing Address - Zip Code:12449-5149
Mailing Address - Country:US
Mailing Address - Phone:845-336-6666
Mailing Address - Fax:845-336-4014
Practice Address - Street 1:1 COMMONS DR
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5149
Practice Address - Country:US
Practice Address - Phone:845-336-6666
Practice Address - Fax:845-336-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5567301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01403185Medicaid
NYWK8391Medicare PIN
NY335765Medicare Oscar/Certification
NYA100000478Medicare PIN