Healthcare Provider Details

I. General information

NPI: 1912614231
Provider Name (Legal Business Name): SPRING CREEK REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S 16TH ST
MURRAY KY
42071-2804
US

IV. Provider business mailing address

51 VIRGINIA AVE
CLIFTON NJ
07012-1222
US

V. Phone/Fax

Practice location:
  • Phone: 270-752-2900
  • Fax:
Mailing address:
  • Phone: 917-613-4386
  • 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: NAFTALI WEISS
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 917-613-4386