Provider Demographics
NPI:1386774818
Name:EGER HARBOR HOUSE
Entity type:Organization
Organization Name:EGER HARBOR HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-554-8701
Mailing Address - Street 1:110 MEISNER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1236
Mailing Address - Country:US
Mailing Address - Phone:718-989-3017
Mailing Address - Fax:718-980-3040
Practice Address - Street 1:110 MEISNER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1236
Practice Address - Country:US
Practice Address - Phone:718-989-3017
Practice Address - Fax:718-980-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02582025Medicaid
NY02582025Medicaid