The W Group at New Broadview, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

610-F-067 Issued in NY

Legal business name

THE W GROUP AT NEW BROADVIEW, LLC

Doing business as

New Broadview Manor Home for Adults
New Broadview Manor Home for Adults LHCSA

Practice address

70 Father Capodanno Blvd
Staten Island, NY 10305-4803

Phone

(718) 840-3355

Fax

(347) 436-8045

NPI assigned

Mar 8, 2018

Last updated

Oct 15, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jennifer Grajales

Title

Project Manager

Phone

(718) 840-3355

Specialties & licenses 3

Addresses

Other names 2

• New Broadview Manor Home for Adults Doing business as
• New Broadview Manor Home for Adults LHCSA Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1033611736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2357 60TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112042689",
            "telephone_number": "718-840-3355",
            "fax_number": "347-436-8045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 FATHER CAPODANNO BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103054803",
            "telephone_number": "718-840-3355",
            "fax_number": "347-436-8045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE W GROUP AT NEW BROADVIEW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-08",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "GRAJALES",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PROJECT MANAGER",
        "authorized_official_telephone_number": "718-840-3355",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NY",
            "license": "2670L001",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NY",
            "license": "610-F-067",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NY",
            "license": "610-F-067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Broadview Manor Home for Adults",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "New Broadview Manor Home for Adults LHCSA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Providers in Staten Island, NY by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.