Provider Demographics
NPI:1912072208
Name:JEWISH HOME LIFECARE HARRY AND JEANETTE WEINBERG CAMPUS BRONX
Entity Type:Organization
Organization Name:JEWISH HOME LIFECARE HARRY AND JEANETTE WEINBERG CAMPUS BRONX
Other - Org Name:THE NEW JEWISH HOME, HARRY AND JEANETTE WEINBERG CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:DSW
Authorized Official - Phone:212-870-4600
Mailing Address - Street 1:100 W KINGSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-3903
Mailing Address - Country:US
Mailing Address - Phone:718-410-1500
Mailing Address - Fax:
Practice Address - Street 1:100 W KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3903
Practice Address - Country:US
Practice Address - Phone:718-410-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000317N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00313520Medicaid
NY335462Medicare Oscar/Certification