Healthcare Provider Details

I. General information

NPI: 1679573109
Provider Name (Legal Business Name): SAN SIMEON BY THE SOUND CENTER FOR NURSING AND REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61700 ROUTE 48
GREENPORT NY
11944-2206
US

IV. Provider business mailing address

61700 ROUTE 48
GREENPORT NY
11944-2206
US

V. Phone/Fax

Practice location:
  • Phone: 631-477-2110
  • Fax:
Mailing address:
  • Phone: 631-477-2110
  • Fax: 631-477-3987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5127300N
License Number StateNY

VIII. Authorized Official

Name: MR. STEVEN SMYTH
Title or Position: ADMINISTRATOR
Credential:
Phone: 631-477-2110