| NPI | 1174896062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAIL MATHESON Lpn 917-459-0596 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3140N1450X Skilled Nursing Facility Nursing Care, Pediatric (Licence: NY 215034) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: NY 215034) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2020-05-21 |