Provider Demographics
NPI:1598830614
Name:THE JEWISH HOME & HOSPITAL FOR AGED
Entity Type:Organization
Organization Name:THE JEWISH HOME & HOSPITAL FOR AGED
Other - Org Name:JEWISH HOME & HOSPITAL LIFECARE COMMUNITY SERVICES-MANHATTAN LTHHCP
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:DSW
Authorized Official - Phone:212-870-4600
Mailing Address - Street 1:404 5TH AVE
Mailing Address - Street 2:7TH FLOOR LTHHCP
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-2797
Mailing Address - Country:US
Mailing Address - Phone:212-273-2500
Mailing Address - Fax:
Practice Address - Street 1:404 5TH AVE
Practice Address - Street 2:7TH FLOOR LTHHCP
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-2797
Practice Address - Country:US
Practice Address - Phone:212-273-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002903L251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00629167Medicaid
NY00629167Medicaid