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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