Provider Demographics
NPI:1942370994
Name:THE BAPTIST HOME OF BROOKLYN, NY
Entity Type:Organization
Organization Name:THE BAPTIST HOME OF BROOKLYN, NY
Other - Org Name:THE BAPTIST HOME AT BROOKMEADE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:845-876-2071
Mailing Address - Street 1:46 BROOKMEADE DRIVE
Mailing Address - Street 2:THE BAPTIST HOME AT BROOKMEADE
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572
Mailing Address - Country:US
Mailing Address - Phone:845-876-2071
Mailing Address - Fax:
Practice Address - Street 1:46 BROOKMEADE DRIVE
Practice Address - Street 2:THE BAPTIST HOME AT BROOKMEADE
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572
Practice Address - Country:US
Practice Address - Phone:845-876-2071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1327301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00312538Medicaid
NY33-5613Medicare ID - Type UnspecifiedFI PROVIDER NUMBER
NY00312538Medicaid