Provider Demographics
NPI:1629003892
Name:ISABELLA GERIATRIC CENTER
Entity Type:Organization
Organization Name:ISABELLA GERIATRIC CENTER
Other - Org Name:ISABELLA ADULT DAY HEALTH CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KATOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-342-9300
Mailing Address - Street 1:515 AUDUBON AVE
Mailing Address - Street 2:ATTN: FINANCE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3403
Mailing Address - Country:US
Mailing Address - Phone:212-342-9309
Mailing Address - Fax:212-781-6303
Practice Address - Street 1:515 AUDUBON AVE
Practice Address - Street 2:ATTN: FINANCE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3403
Practice Address - Country:US
Practice Address - Phone:212-342-9309
Practice Address - Fax:212-781-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002352N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02099461Medicaid