| NPI | 1063419356 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA BURTON Administrator 631-299-3190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: NY 5154321N) |
| Additional Taxonomies | 261QA0600X Clinic/Center, Adult Day Care |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2023-06-08 |