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Organization
STATE OF NEW YORK
Active
Organization
STATE OF NEW YORK
Active
Parent organization
STATE OF NEW YORK
Other names
B Fineson DC Corona II ICF
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF NEW YORK
Authorized official
KARLA SMITH (DIRECTOR OF CENTRAL OPERATIONS)
(518) 402-4333
Entity
Organization
Contact information
Practice address
8045 WINCHESTER BLVD, QUEENS VILLAGE, NY 11427-2193
(518) 402-4333
Mailing address
44 HOLLAND AVE, ALBANY, NY 12229-0001
(518) 402-4333
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
230CORII
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01358763
—
NY
Enumeration date
02/06/2007
Last updated
08/27/2008
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