Healthcare Provider Details

I. General information

NPI: 1124299128
Provider Name (Legal Business Name): PALM TREE CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5606 15TH AVE
BROOKLYN NY
11219-4708
US

IV. Provider business mailing address

5606 15TH AVE
BROOKLYN NY
11219-4708
US

V. Phone/Fax

Practice location:
  • Phone: 718-851-1000
  • Fax: 718-732-3243
Mailing address:
  • Phone: 718-851-1000
  • Fax: 718-732-3243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7001392N
License Number StateNY

VIII. Authorized Official

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