Healthcare Provider Details

I. General information

NPI: 1245407220
Provider Name (Legal Business Name): CARILLON NURSING & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PARK AVE
HUNTINGTON NY
11743-4543
US

IV. Provider business mailing address

830 PARK AVE
HUNTINGTON NY
11743-4543
US

V. Phone/Fax

Practice location:
  • Phone: 631-271-5800
  • Fax:
Mailing address:
  • Phone: 631-271-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5153306N
License Number StateNY

VIII. Authorized Official

Name: JOSEPH F CARILLO II
Title or Position: MANAGING MEMBER
Credential:
Phone: 631-271-5800