Provider Demographics
NPI:1821469941
Name:DRY HARBOR HRF INC
Entity Type:Organization
Organization Name:DRY HARBOR HRF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MAYER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-565-4200
Mailing Address - Street 1:6135 DRY HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1528
Mailing Address - Country:US
Mailing Address - Phone:718-565-4200
Mailing Address - Fax:718-505-7850
Practice Address - Street 1:6135 DRY HARBOR RD
Practice Address - Street 2:SUITE 284
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1528
Practice Address - Country:US
Practice Address - Phone:718-565-4200
Practice Address - Fax:718-505-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003359N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995751Medicaid