Healthcare Provider Details

I. General information

NPI: 1831159664
Provider Name (Legal Business Name): MARCUS GARVEY RESIDENTIAL REHAB PAVILION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 SAINT MARKS AVE
BROOKLYN NY
11213-1420
US

IV. Provider business mailing address

810 SAINT MARKS AVE
BROOKLYN NY
11213-1420
US

V. Phone/Fax

Practice location:
  • Phone: 718-467-7300
  • Fax: 718-467-7878
Mailing address:
  • Phone: 718-467-7300
  • Fax: 718-467-7878

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: DARNELL J COY
Title or Position: CFO
Credential:
Phone: 718-467-7300