Healthcare Provider Details

I. General information

NPI: 1669182804
Provider Name (Legal Business Name): SAN ANDREAS SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249-9713
US

IV. Provider business mailing address

1777 AVENUE OF THE STATES STE 102
LAKEWOOD NJ
08701-4779
US

V. Phone/Fax

Practice location:
  • Phone: 917-251-2850
  • Fax:
Mailing address:
  • Phone: 917-251-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SHIMON SPIELMAN
Title or Position: CFO
Credential:
Phone: 917-251-2850