Provider Demographics
NPI:1346601531
Name:CATHOLIC MANAGED LTC INC
Entity Type:Organization
Organization Name:CATHOLIC MANAGED LTC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ENEIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-732-7171
Mailing Address - Street 1:109 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1510
Mailing Address - Country:US
Mailing Address - Phone:914-668-3068
Mailing Address - Fax:
Practice Address - Street 1:109 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-1510
Practice Address - Country:US
Practice Address - Phone:914-668-3068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization