Healthcare Provider Details

I. General information

NPI: 1790772242
Provider Name (Legal Business Name): SHEEPSHEAD NURSING AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 KNAPP ST
BROOKLYN NY
11235-1112
US

IV. Provider business mailing address

2840 KNAPP ST
BROOKLYN NY
11235-1112
US

V. Phone/Fax

Practice location:
  • Phone: 718-646-5700
  • Fax: 718-646-3499
Mailing address:
  • Phone: 718-646-5700
  • Fax: 718-646-3499

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: MR. JEROME KAHAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-646-5700