Provider Demographics
NPI:1518019827
Name:THE WARTBURG RESIDENTIAL COMMUNITY, INC.
Entity Type:Organization
Organization Name:THE WARTBURG RESIDENTIAL COMMUNITY, INC.
Other - Org Name:WARTBURG CARE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-513-5311
Mailing Address - Street 1:1 WARTBURG PL
Mailing Address - Street 2:BLDG 10, 2ND FLOOR
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3821
Mailing Address - Country:US
Mailing Address - Phone:914-513-5656
Mailing Address - Fax:
Practice Address - Street 1:1 WARTBURG PL
Practice Address - Street 2:BLDG 10, 2ND FLOOR
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3821
Practice Address - Country:US
Practice Address - Phone:914-513-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9482L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01660457Medicaid