Provider Demographics
NPI:1962563353
Name:YONKERS RESIDENTIAL CENTER,INC.
Entity type:Organization
Organization Name:YONKERS RESIDENTIAL CENTER,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CORKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-476-6502
Mailing Address - Street 1:317 S BROADWAY
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-2008
Mailing Address - Country:US
Mailing Address - Phone:914-476-6502
Mailing Address - Fax:914-476-2421
Practice Address - Street 1:317 S BROADWAY
Practice Address - Street 2:1ST FLOOR
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-2008
Practice Address - Country:US
Practice Address - Phone:914-476-6502
Practice Address - Fax:914-476-2421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01072251Medicaid