Healthcare Provider Details

I. General information

NPI: 1265429856
Provider Name (Legal Business Name): CARILLON NURSING AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
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: 631-271-5806
Mailing address:
  • Phone: 631-271-5800
  • Fax: 631-271-5806

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: MR. JOSEPH F CARILLO II
Title or Position: ADMINISTRATOR
Credential:
Phone: 631-271-5800