Provider Demographics
NPI:1750573028
Name:BRONX JEWISH COMMUNITY COUNCIL -HOME ATTENDANT SERVICES INC
Entity type:Organization
Organization Name:BRONX JEWISH COMMUNITY COUNCIL -HOME ATTENDANT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHIBONG
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:10467-8404
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:10467-8404
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:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9824L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00924332Medicaid