Provider Demographics
NPI:1063586766
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:<UNAVAIL>
Other - Org Type:
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 1:2545 UNIVERSITY AVE
Mailing Address - Street 2:ATTN BRONX LTHHCP
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4066
Mailing Address - Country:US
Mailing Address - Phone:718-367-1125
Mailing Address - Fax:
Practice Address - Street 1:2545 UNIVERSITY AVE
Practice Address - Street 2:ATTN BRONX LTHHCP
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-4066
Practice Address - Country:US
Practice Address - Phone:718-367-1125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000902L251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00708214Medicaid
NY00708214Medicaid