Provider Demographics
NPI:1407132020
Name:GELLER HOUSE
Entity Type:Organization
Organization Name:GELLER HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-442-7828
Mailing Address - Street 1:180 TRANTOR PL
Mailing Address - Street 2:3C
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1959
Mailing Address - Country:US
Mailing Address - Phone:917-324-5015
Mailing Address - Fax:
Practice Address - Street 1:77 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3757
Practice Address - Country:US
Practice Address - Phone:718-448-7828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY592180313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility