Healthcare Provider Details

I. General information

NPI: 1346124781
Provider Name (Legal Business Name): NILES CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 S 3RD ST
NILES MI
49120-3414
US

IV. Provider business mailing address

1200 RIVER AVE STE 7B-18
LAKEWOOD NJ
08701-5657
US

V. Phone/Fax

Practice location:
  • Phone: 269-684-4320
  • Fax:
Mailing address:
  • Phone: 718-807-1940
  • 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: MOSHE GOTTLIEB
Title or Position: MEMBER
Credential:
Phone: 718-807-1941