Provider Demographics
NPI:1699818708
Name:CATH CHAR NGHBHD SVS DONALD SAVIO ICF
Entity Type:Organization
Organization Name:CATH CHAR NGHBHD SVS DONALD SAVIO ICF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-722-6123
Mailing Address - Street 1:191 JORALEMON ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4306
Mailing Address - Country:US
Mailing Address - Phone:718-722-6180
Mailing Address - Fax:718-722-6219
Practice Address - Street 1:10422 48TH AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2837
Practice Address - Country:US
Practice Address - Phone:718-699-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES NEIGHBORHOOD SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-15
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01013607Medicaid