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Organization
BRONX LEBANON HOSPITAL LIFE RECOVERY CENTER
Active
Organization
BRONX LEBANON HOSPITAL LIFE RECOVERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEMETRIA NELSON LCSW (PROGRAM ADMINISTRATOR)
(718) 518-3736
Entity
Organization
Contact information
Practice address
1285 FULTON AVE, BRONX, NY 10456-3401
(718) 518-3711
Mailing address
28 DIXON ST, TARRYTOWN, NY 10591-3304
(914) 414-2829
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
0738591
NY
Other
Enumeration date
02/23/2015
Last updated
02/23/2015
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