Provider Demographics
NPI:1841475506
Name:FORT TRYON REHABILITATION & HEALTH CARE FACILITY LLC
Entity type:Organization
Organization Name:FORT TRYON REHABILITATION & HEALTH CARE FACILITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-543-6400
Mailing Address - Street 1:3525 BAYCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-5001
Mailing Address - Country:US
Mailing Address - Phone:718-298-3900
Mailing Address - Fax:718-298-3901
Practice Address - Street 1:3525 BAYCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-5001
Practice Address - Country:US
Practice Address - Phone:718-298-3900
Practice Address - Fax:718-298-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02942441Medicaid
NY02942441Medicaid