MEDICARE: PELHAM PARKWAY NURSING CARE & REHABILITATION FACILITY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306827456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELHAM PARKWAY NURSING CARE & REHABILITATION FACILITY, LLC

Provider Business Mailing Address
First Line	:	2401 LACONIA AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-1406
Country	:	US
Telephone Number	:	718-798-8600
Fax Number	:	718-654-1057

Provider Business Practice Location Address
First Line	:	2401 LACONIA AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-1406
Country	:	US
Telephone Number	:	718-798-8600
Fax Number	:	718-654-1057

Authorized Official
Title or Position	:	OWNER
Name	:	OTTO WEINGARTEN
Credential	:
Telephone Number	:	718-798-8600

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/18/2008

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