Healthcare Provider Details

I. General information

NPI: 1821086448
Provider Name (Legal Business Name): WEDGEWOOD CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 COMMUNITY DR
GREAT NECK NY
11021-5502
US

IV. Provider business mailing address

199 COMMUNITY DR
GREAT NECK NY
11021-5502
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-9229
  • Fax: 516-365-2381
Mailing address:
  • Phone: 516-365-9229
  • Fax: 516-365-2381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2951306N
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RAFI MOTECHIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 516-303-0100