Organization
ST. THERESA'S RESIDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE ADLER (VICE PRESIDENT OF FINANCE)
(646) 633-4710
Entity
Organization
Contact information
Practice address
30 S 10TH AVE, MT VERNON, NY 10550-2907
(914) 664-5900
Mailing address
30 S 10TH AVE, MT VERNON, NY 10550-2907
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
7482440
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00729617
—
NY
Enumeration date
05/30/2007
Last updated
08/22/2020
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