Provider Demographics
NPI:1629131131
Name:CARDINAL HAYES HOME FOR CHILDREN
Entity Type:Organization
Organization Name:CARDINAL HAYES HOME FOR CHILDREN
Other - Org Name:GASPARRO DRIVE ICF
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:APERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-677-6363
Mailing Address - Street 1:60 ST JOSEPH DR
Mailing Address - Street 2:PO BOX CH
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545
Mailing Address - Country:US
Mailing Address - Phone:845-677-6363
Mailing Address - Fax:845-677-6691
Practice Address - Street 1:60 ST JOSEPH DR
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545
Practice Address - Country:US
Practice Address - Phone:845-677-6363
Practice Address - Fax:845-677-6691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00728872Medicaid