Provider Demographics
NPI:1336309954
Name:PESACH TIKVAH HOPE DEVELOPMENT INC.
Entity Type:Organization
Organization Name:PESACH TIKVAH HOPE DEVELOPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPA COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BASSHEVY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-875-6900
Mailing Address - Street 1:18 MIDDLETON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:274 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7305
Practice Address - Country:US
Practice Address - Phone:718-782-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00877005Medicaid