Provider Demographics
NPI:1902012271
Name:WOMENS LEAGUE COMMUNITY RESIDENCE
Entity Type:Organization
Organization Name:WOMENS LEAGUE COMMUNITY RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-853-0900
Mailing Address - Street 1:1556 38TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4408
Mailing Address - Country:US
Mailing Address - Phone:718-853-0900
Mailing Address - Fax:718-633-6816
Practice Address - Street 1:4022 12TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1907
Practice Address - Country:US
Practice Address - Phone:718-853-0900
Practice Address - Fax:718-633-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01156647Medicaid