St. Theresa'S Residence

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

7482440 Issued in NY

Legal business name

ST. THERESA'S RESIDENCE

Practice address

30 S 10TH Ave
Mt Vernon, NY 10550-2907

Phone

(914) 664-5900

NPI assigned

May 30, 2007

Organization subpart

No

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

Authorized official

Name

Bruce Adler

Title

Vice President of Finance

Phone

(646) 633-4710

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275734030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 S 10TH AVE",
            "city": "MT VERNON",
            "state": "NY",
            "postal_code": "105502907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 S 10TH AVE",
            "city": "MT VERNON",
            "state": "NY",
            "postal_code": "105502907",
            "telephone_number": "914-664-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. THERESA'S RESIDENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ADLER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "646-633-4710"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NY",
            "license": "7482440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00729617",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alaisia Spence
• Rosalyn Dorothy Spence
• Yvonne Spencer
• Robert Spiel
• Sowmya Sreekanth, MD
• Kimberly Stanley, RN
• Susan Marie Stanton, LMSW, CSSWS,
• Statewwide Ambulette Ser., Inc.
• Ariel Stein, D.M.D
• Sterling Ambulette, Inc.

• Intellectual Disabilities Intermediate Care Facility in Mt Vernon, NY
• Providers in Mt Vernon, NY by specialty
• Intellectual Disabilities Intermediate Care Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.