Provider Demographics
NPI:1023662616
Name:BRONX JEWISH COMMUNITY COUNCIL HOME ATTENDANT SERVICES
Entity type:Organization
Organization Name:BRONX JEWISH COMMUNITY COUNCIL HOME ATTENDANT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-652-5500
Mailing Address - Street 1:2930 WALLACE AVE.
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-652-5500
Mailing Address - Fax:718-798-2398
Practice Address - Street 1:2930 WALLACE AVE.
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-652-5500
Practice Address - Fax:718-798-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00924332Medicaid