Healthcare Provider Details

I. General information

NPI: 1306504998
Provider Name (Legal Business Name): GK CORAM OPERATING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 12/01/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 MIDDLE COUNTRY RD
CORAM NY
11727-3758
US

IV. Provider business mailing address

100 JERICHO QUADRANGLE STE 142
JERICHO NY
11753-2702
US

V. Phone/Fax

Practice location:
  • Phone: 516-997-0010
  • Fax:
Mailing address:
  • Phone: 516-496-1505
  • Fax: 516-209-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND DIOGUARDI
Title or Position: COO/CFO
Credential:
Phone: 516-496-1505