Provider Demographics
NPI:1720443047
Name:THE HEBREW HOME FOR THE AGED AT RIVERDALE
Entity Type:Organization
Organization Name:THE HEBREW HOME FOR THE AGED AT RIVERDALE
Other - Org Name:RIVERSPRING OUTPATIENT REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-581-1313
Mailing Address - Street 1:5901 PALISADE AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:718-581-1313
Mailing Address - Fax:718-709-4277
Practice Address - Street 1:5901 PALISADE AVENUE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NY
Practice Address - Zip Code:10471
Practice Address - Country:US
Practice Address - Phone:718-581-1313
Practice Address - Fax:718-709-4277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEBREW HOME FOR THE AGED AT RIVERDALE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310316Medicaid
NY33-5020Medicare UPIN
NY00310316Medicaid