Provider Demographics
NPI:1447702253
Name:THE WARTBURG HOME OF THE EVANGELICAL LUTHERAN CHURCH
Entity type:Organization
Organization Name:THE WARTBURG HOME OF THE EVANGELICAL LUTHERAN CHURCH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-513-5311
Mailing Address - Street 1:1 WARTBURG PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3821
Mailing Address - Country:US
Mailing Address - Phone:914-699-0800
Mailing Address - Fax:
Practice Address - Street 1:1 WARTBURG PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3821
Practice Address - Country:US
Practice Address - Phone:914-699-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5903309N261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care