Provider Demographics
NPI:1790879146
Name:METHODIST CHURCH HOME FOR THE AGED IN THE CITY OF NEW YORK
Entity Type:Organization
Organization Name:METHODIST CHURCH HOME FOR THE AGED IN THE CITY OF NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-548-5100
Mailing Address - Street 1:4499 MANHATTAN COLLEGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:718-548-5100
Mailing Address - Fax:718-548-3147
Practice Address - Street 1:4499 MANHATTAN COLLEGE PARKWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471
Practice Address - Country:US
Practice Address - Phone:718-548-5100
Practice Address - Fax:718-548-3147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
NY04740376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Single Specialty
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00313548Medicaid
NY1204560001Medicare NSC
NY335524Medicare Oscar/Certification