Organization
PROVIDENCE REST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN M STEINBERG LNHA (ADMINISTRATOR)
(718) 931-3000
Entity
Organization
Contact information
Practice address
3304 WATERBURY AVE, BRONX, NY 10465-1554
(718) 931-3000
(718) 514-8447
Mailing address
3304 WATERBURY AVE, BRONX, NY 10465-1554
(718) 931-3000
(718) 514-8447
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
7000306N
NY
385H00000X
Respite Care
7000306N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00309357
—
NY
01
—
007381
BLUE CROSS/ BLUE SHIELD
NY
05
—
01133297
—
NY
01
—
1216
FACILITY
NY
Enumeration date
07/19/2005
Last updated
07/08/2015
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