Provider Demographics
NPI:1568435402
Name:ST. PATRICK'S HOME FOR THE AGED AND INFIRM
Entity Type:Organization
Organization Name:ST. PATRICK'S HOME FOR THE AGED AND INFIRM
Other - Org Name:ST. PATRICK'S HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER PATRICK
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:O'CARM
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:718-519-2800
Mailing Address - Street 1:66 VAN CORTLANDT PARK S
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3102
Mailing Address - Country:US
Mailing Address - Phone:718-519-2800
Mailing Address - Fax:
Practice Address - Street 1:66 VAN CORTLANDT PARK S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3102
Practice Address - Country:US
Practice Address - Phone:718-519-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03A1313314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00309384Medicaid
NY00309384Medicaid