Provider Demographics
NPI:1104968189
Name:KINGSBRIDGE HEIGHTS CARE CTR INC.
Entity type:Organization
Organization Name:KINGSBRIDGE HEIGHTS CARE CTR INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARETT
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:718-796-8100
Mailing Address - Street 1:3400 CANNON PL.
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-796-8100
Mailing Address - Fax:718-796-8182
Practice Address - Street 1:3400 CANNON PL.
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:718-796-8100
Practice Address - Fax:718-796-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149631-1310400000X
NY7000374N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00309742Medicaid
NY00309742Medicaid