Provider Demographics
NPI:1467722017
Name:JUDITH LYNN HOME FOR ADULTS, LLC
Entity Type:Organization
Organization Name:JUDITH LYNN HOME FOR ADULTS, LLC
Other - Org Name:AMBER COURT OF PELHAM GARDENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-334-3838
Mailing Address - Street 1:1800 WARING AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-6331
Mailing Address - Country:US
Mailing Address - Phone:718-379-4400
Mailing Address - Fax:
Practice Address - Street 1:1800 WARING AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-6331
Practice Address - Country:US
Practice Address - Phone:718-379-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020-F-817310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility