Provider Demographics
NPI:1528038429
Name:NORWEGIAN CHRISTIAN HHCC ALP
Entity Type:Organization
Organization Name:NORWEGIAN CHRISTIAN HHCC ALP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-232-2322
Mailing Address - Street 1:1250 67TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5921
Mailing Address - Country:US
Mailing Address - Phone:718-232-2322
Mailing Address - Fax:718-331-5111
Practice Address - Street 1:1250 67TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5921
Practice Address - Country:US
Practice Address - Phone:718-232-2322
Practice Address - Fax:718-331-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0547L001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02473825Medicaid