Healthcare Provider Details

I. General information

NPI: 1275181257
Provider Name (Legal Business Name): AXIS HEALTH AT MANOKIN OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11974 EDGEHILL TERRACE RD
PRINCESS ANNE MD
21853-2105
US

IV. Provider business mailing address

22 PLEASANT RIDGE RD
SPRING VALLEY NY
10977-1609
US

V. Phone/Fax

Practice location:
  • Phone: 410-651-0011
  • Fax:
Mailing address:
  • Phone: --
  • 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: BENT PHILIPSON
Title or Position: MEMBER
Credential:
Phone: 516-869-3700