MEDICARE: GRAND MANOR HEALTH RELATED FACILITY INC.

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	00358021	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	335744	OTHER	NY	MEDICARE

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	:	1588667125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND MANOR HEALTH RELATED FACILITY INC.

Provider Business Mailing Address
First Line	:	700 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-2634
Country	:	US
Telephone Number	:	718-518-8892
Fax Number	:	718-931-5994

Provider Business Practice Location Address
First Line	:	700 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-2634
Country	:	US
Telephone Number	:	718-518-8892
Fax Number	:	718-931-5994

Authorized Official
Title or Position	:	OPERATOR
Name	:	MR. MARTIN LIEBMAN
Credential	:
Telephone Number	:	718-518-8892

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/25/2015

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