National Provider Identifier Database

ST THERESAS RESIDENCE
Intermediate Care Facility, Mentally Retarded

(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.


Contact Information

ST. THERESA'S RESIDENCE
30 S 10TH AVE
MOUNT VERNON, NY10550-2907
Phone: 914-664-5900
Fax:
Website:
Specialty Taxonomy Code
* Intermediate Care Facility, Mentally Retarded 315P00000X

* Indicates primary specialty

NPI Profile & details for ST. THERESA'S RESIDENCE

NPI Number 1275734030
Legal business name
LBN
ST. THERESA'S RESIDENCE
Authorized official BRUCE ADLER - (VICE PRESIDENT OF FINANCE)
Entity Organization
Organization subpart No
Enumeration date 05/30/2007
Last updated 08/22/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • NY License #: 7482440
  • NY Medicaid: 00729617

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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