Healthcare Provider Details

I. General information

NPI: 1699280826
Provider Name (Legal Business Name): 239 LEGRIS AVENUE OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 QUENTIN RD
BROOKLYN NY
11234-4235
US

IV. Provider business mailing address

3118 QUENTIN RD
BROOKLYN NY
11234-4235
US

V. Phone/Fax

Practice location:
  • Phone: 718-975-4714
  • 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: LOUIS GELLIS
Title or Position: OWNER
Credential:
Phone: 718-975-4713