Provider Demographics
NPI:1326109745
Name:THE ROBERT MAPPLETHORPE RESIDENTIAL TREATMENT FACILITY BETH ISREAL NUR
Entity Type:Organization
Organization Name:THE ROBERT MAPPLETHORPE RESIDENTIAL TREATMENT FACILITY BETH ISREAL NUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH LNHA
Authorized Official - Phone:212-420-5693
Mailing Address - Street 1:160 WATER STREET
Mailing Address - Street 2:ROOM 2329
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:212-256-3027
Mailing Address - Fax:212-256-3595
Practice Address - Street 1:327 E 17TH
Practice Address - Street 2:THE ROBERT MAPPLETHORPE RESIDENTIAL TREATMENT CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-420-5693
Practice Address - Fax:212-256-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002351N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01476104Medicaid