Provider Demographics
NPI:1104956754
Name:UNITED STATES CATHOLIC CONFERENCE ST. CABRINI HOME, INC.
Entity type:Organization
Organization Name:UNITED STATES CATHOLIC CONFERENCE ST. CABRINI HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCTS RECEIVABLES
Authorized Official - Prefix:
Authorized Official - First Name:LIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGNANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-383-3913
Mailing Address - Street 1:CABRINI HOME, INC.
Mailing Address - Street 2:2085 RT 9W
Mailing Address - City:WEST PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12493
Mailing Address - Country:US
Mailing Address - Phone:845-384-6500
Mailing Address - Fax:845-384-6001
Practice Address - Street 1:CABRINI HOME, INC.
Practice Address - Street 2:2085 RT 9W
Practice Address - City:WEST PARK
Practice Address - State:NY
Practice Address - Zip Code:12493
Practice Address - Country:US
Practice Address - Phone:845-384-6500
Practice Address - Fax:845-384-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012789261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07317OtherNYSOASAS PRU NUMBER
NY081111324OtherCERTIFICATE NUMBER
NY41990OtherPROGRAM PROVIDER NUMBER
NY02324550Medicaid
NY012789OtherLICENSE NUMBER