Provider Demographics
NPI:1831358522
Name:MT. SINAI GUEST HOME
Entity type:Organization
Organization Name:MT. SINAI GUEST HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-731-0026
Mailing Address - Street 1:1800 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-6023
Mailing Address - Country:US
Mailing Address - Phone:323-734-1705
Mailing Address - Fax:323-732-3411
Practice Address - Street 1:1800 12TH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-6023
Practice Address - Country:US
Practice Address - Phone:323-734-1705
Practice Address - Fax:323-732-3411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198601075261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities