Provider Demographics
NPI:1326025578
Name:ST. BARNABAS NURSING HOME INC.
Entity Type:Organization
Organization Name:ST. BARNABAS NURSING HOME INC.
Other - Org Name:ST. BARNABAS REHABILITATION & CONTINUING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROCHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-960-3839
Mailing Address - Street 1:2175 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-1663
Mailing Address - Country:US
Mailing Address - Phone:718-960-3980
Mailing Address - Fax:718-960-3998
Practice Address - Street 1:2175 QUARRY ROAD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-1663
Practice Address - Country:US
Practice Address - Phone:718-960-3980
Practice Address - Fax:718-960-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000371N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01476255Medicaid
NY7000371NOtherOPERATING CERTIFICATE #
NY4887OtherNYSDOH PFI#
NY335775Medicare ID - Type Unspecified
NY01476255Medicaid