Provider Demographics
NPI:1053523027
Name:SERVANTS OF RELIEF FOR INCURABLE CANCER
Entity type:Organization
Organization Name:SERVANTS OF RELIEF FOR INCURABLE CANCER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SR. MARY
Authorized Official - Middle Name:FLORENCE
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:212-677-8132
Mailing Address - Street 1:71 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-8201
Mailing Address - Country:US
Mailing Address - Phone:212-677-8132
Mailing Address - Fax:212-982-3485
Practice Address - Street 1:71 JACKSON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-8201
Practice Address - Country:US
Practice Address - Phone:212-677-8132
Practice Address - Fax:212-982-3485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002307N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility