Healthcare Provider Details

I. General information

NPI: 1295772010
Provider Name (Legal Business Name): THE PALM GARDENS CENTER FOR NURSING AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 AVENUE C
BROOKLYN NY
11218-4101
US

IV. Provider business mailing address

615 AVENUE C
BROOKLYN NY
11218-4101
US

V. Phone/Fax

Practice location:
  • Phone: 718-633-3300
  • Fax: 718-732-3243
Mailing address:
  • Phone: 718-633-3300
  • Fax: 718-732-3243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number7001335N
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7001335N
License Number StateNY

VIII. Authorized Official

Name: MR. SHIMON LEFKOWITZ
Title or Position: CEO
Credential:
Phone: 718-633-3300