| NPI | 1891914537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY K ST. MARK Director Of The Billing Department 718-920-0806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |