Provider Demographics
NPI:1336650902
Name:THE WARTBURG HOME OF THE EVANGELICAL LUTHERAN CHURCH, INC.
Entity Type:Organization
Organization Name:THE WARTBURG HOME OF THE EVANGELICAL LUTHERAN CHURCH, INC.
Other - Org Name:WARTBURG SOCIAL ADULT DAY CARE @ BETHESDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUDGET & REIMBURSEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-513-5106
Mailing Address - Street 1:1 WARTBURG PL BLDG 6
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3821
Mailing Address - Country:US
Mailing Address - Phone:914-513-5106
Mailing Address - Fax:914-699-2512
Practice Address - Street 1:71 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-3922
Practice Address - Country:US
Practice Address - Phone:914-513-5472
Practice Address - Fax:914-699-2512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5903309N261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care