Provider Demographics
NPI:1801833652
Name:PROMESA RESIDENTIAL HEALTH CARE FACILITY, INC.
Entity Type:Organization
Organization Name:PROMESA RESIDENTIAL HEALTH CARE FACILITY, INC.
Other - Org Name:CASA PROMESA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:GATELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-960-7568
Mailing Address - Street 1:311 E 175TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5859
Mailing Address - Country:US
Mailing Address - Phone:718-960-7568
Mailing Address - Fax:
Practice Address - Street 1:308 E 175TH STREET
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:347-649-3083
Practice Address - Fax:347-649-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01547355Medicaid
NY335780Medicare Oscar/Certification