Healthcare Provider Details

I. General information

NPI: 1972893683
Provider Name (Legal Business Name): KFG OPERATING I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 DEAN ST
BROOKLYN NY
11217-2213
US

IV. Provider business mailing address

155 DEAN ST
BROOKLYN NY
11217-2213
US

V. Phone/Fax

Practice location:
  • Phone: 718-694-6700
  • Fax: 718-694-6710
Mailing address:
  • Phone: 718-694-6700
  • Fax: 718-694-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7001377N
License Number StateNY

VIII. Authorized Official

Name: CHARLES-EDOUARD GROS
Title or Position: MANAGING MEMBER
Credential:
Phone: 718-360-8083