Provider Demographics
NPI:1467452946
Name:CHAPIN HOME FOR THE AGING
Entity Type:Organization
Organization Name:CHAPIN HOME FOR THE AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:O'HARA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, JD
Authorized Official - Phone:718-739-2523
Mailing Address - Street 1:16501 CHAPIN PKWY
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1807
Mailing Address - Country:US
Mailing Address - Phone:718-739-2523
Mailing Address - Fax:718-291-0989
Practice Address - Street 1:16501 CHAPIN PKWY
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1807
Practice Address - Country:US
Practice Address - Phone:718-739-2523
Practice Address - Fax:718-291-0989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003351314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY362230Medicaid
NY335631Medicare ID - Type Unspecified