Organization
PUERTO RICAN FAMILY LACONIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARL CINA (CONTROLLER)
(212) 229-6921
Entity
Organization
Contact information
Practice address
145 W 15TH ST FL 2, NEW YORK, NY 10011-6701
(212) 414-7822
(212) 691-5635
Mailing address
3050 LACONIA AVE, BRONX, NY 10469-1402
(212) 414-7822
(212) 691-5635
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
06270440
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00357135
—
NY
Enumeration date
08/01/2007
Last updated
03/24/2008
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