Bronx Lebanon Hospital Life Recovery Center

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

0738591 Issued in NY

Legal business name

BRONX LEBANON HOSPITAL LIFE RECOVERY CENTER

Practice address

1285 Fulton Ave
Bronx, NY 10456-3401

Phone

(718) 518-3711

NPI assigned

Feb 23, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Demetria Nelson, LCSW

Title

Program Administrator

Phone

(718) 518-3736

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1424649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424649600000",
    "number": "1578955951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 DIXON ST",
            "city": "TARRYTOWN",
            "state": "NY",
            "postal_code": "105913304",
            "telephone_number": "914-414-2829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1285 FULTON AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104563401",
            "telephone_number": "718-518-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONX LEBANON HOSPITAL LIFE RECOVERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-23",
        "last_updated": "2015-02-23",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "DEMETRIA",
        "authorized_official_title_or_position": "PROGRAM ADMINISTRATOR",
        "authorized_official_telephone_number": "718-518-3736",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NY",
            "license": "0738591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bronx Kids Pediatric Dentistry
• Bronx Lebanon Hospital
• Bronx Lebanon Hospital Center
• Bronx Lebanon Hospital Center
• Bronx Lebanon Hospital Center
• Bronx Lebanon Nephrology, PLLC
• Bronx Medical Art PC
• Bronx Medical Care Assoc., P.C
• Bronx Medical Diagnostic, P.C.
• Bronx Medical Health Services

• Mental Health Clinic/Center (Including Community Mental Health Center) in Bronx, NY
• Providers in Bronx, NY by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2015; 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.