Provider Demographics
NPI:1417021239
Name:WARTBURG ADULT DAY CARE BROOKLYN
Entity Type:Organization
Organization Name:WARTBURG ADULT DAY CARE BROOKLYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-345-2273
Mailing Address - Street 1:50 SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-2420
Mailing Address - Country:US
Mailing Address - Phone:718-345-2273
Mailing Address - Fax:718-485-9236
Practice Address - Street 1:50 SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2420
Practice Address - Country:US
Practice Address - Phone:718-345-2273
Practice Address - Fax:718-485-9236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001364N251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01283105-03Medicaid