Provider Demographics
NPI:1639255797
Name:BRONXCARE SPECIAL CARE CENTER
Entity Type:Organization
Organization Name:BRONXCARE SPECIAL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP-CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:G
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:718-901-8600
Mailing Address - Street 1:1276 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3402
Mailing Address - Country:US
Mailing Address - Phone:708-901-8600
Mailing Address - Fax:718-293-1475
Practice Address - Street 1:1265 FULTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:718-901-8600
Practice Address - Fax:718-293-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000364N314000000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01350930Medicaid
NY009491OtherBLUE CROSS
NY009491OtherBLUE CROSS