# BETHABRAHAM HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bainbridge Nursing Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285948570
- **Authorized official:** MS. LORNA DECARLA INNIS OTA (OTA/OTA)
- **Authorized official phone:** (646) 415-1121

## Contact information

- **Practice address:** 3936 BARNES AVE, BRONX, NY 10466-4313
- **Practice address phone:** (646) 415-1121
- **Mailing address:** 3936 BARNES AVE, BRONX, NY 10466-4313
- **Mailing address phone:** (646) 415-1121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251300000X | Local Education Agency (LEA) | 006625-1 | NY | — |
| 252Y00000X | Early Intervention Provider Agency | 006625-1 | NY | — |
| 273Y00000X | Rehabilitation Hospital Unit | 006625-1 | NY | Yes |
| 302R00000X | Health Maintenance Organization | 006625-1 | NY | — |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 006625-1 | NY | — |

## Other

- **Enumeration date:** 07/29/2010
- **Last updated:** 07/29/2010