1013902303 NPI number — SISTERS OF CHARITY HEALTH CARE SYSTEMS NH INC

Table of content: (NPI 1013902303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013902303 NPI number — SISTERS OF CHARITY HEALTH CARE SYSTEMS NH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SISTERS OF CHARITY HEALTH CARE SYSTEMS NH INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAINT ELIZABETH ANNS HCRC AADC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013902303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 VANDERBILT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10304-2604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-876-1355
Provider Business Mailing Address Fax Number:
718-876-4426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 VANDERBILT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10304-2604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-876-1355
Provider Business Practice Location Address Fax Number:
718-876-4426
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCGRANN
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
718-876-2494

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 09185753 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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