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Contact Information

ST. THERESA'S RESIDENCE
30 S 10TH AVE
MOUNT VERNON, NY10550-2907
 Phone: 914-664-5900
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Intermediate Care Facility, Mentally Retarded

315P00000X
Indicates primary specialty

NPI Profile & details for ST. THERESA'S RESIDENCE

NPI # 1275734030
LBN Legal business name ST. THERESA'S RESIDENCE
Authorized official BRUCE ADLER - (VICE PRESIDENT OF FINANCE)
Entity Organization
Organization subpart 1 No
Enumeration date 05/30/2007
Last updated 08/22/2020 - About 6 years ago
Identifiers
NY License # 7482440
NY Medicaid 00729617
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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