Provider Demographics
NPI:1467526160
Name:JEWISH HOME LIFECARE, MANHATTAN
Entity Type:Organization
Organization Name:JEWISH HOME LIFECARE, MANHATTAN
Other - Org Name:THE NEW JEWISH HOME, MANHATTAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-870-4752
Mailing Address - Street 1:1200 WATERS PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2728
Mailing Address - Country:US
Mailing Address - Phone:718-410-1220
Mailing Address - Fax:
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2728
Practice Address - Country:US
Practice Address - Phone:718-410-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWISH HOME LIFECARE, MANHATTAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-17
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002340N261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00313942Medicaid