Provider Demographics
NPI:1316279847
Name:CHILDREN'S REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:CHILDREN'S REHABILITATION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:M. CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-294-6128
Mailing Address - Street 1:317 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2209
Mailing Address - Country:US
Mailing Address - Phone:914-597-4100
Mailing Address - Fax:914-597-4012
Practice Address - Street 1:317 NORTH ST
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2209
Practice Address - Country:US
Practice Address - Phone:914-597-4100
Practice Address - Fax:914-597-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
NY5902212R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03217705Medicaid
NYA100040009Medicare UPIN