Healthcare Provider Details

I. General information

NPI: 1730182254
Provider Name (Legal Business Name): MARGARET TIETZ NURSING AND REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164-11 CHAPIN PKWY
JAMAICA NY
11432
US

IV. Provider business mailing address

1250 WATERS PLACE TOWER 1, SUITE 602
BRONX NY
10461-2731
US

V. Phone/Fax

Practice location:
  • Phone: 718-298-7800
  • Fax: 718-262-8839
Mailing address:
  • Phone: 718-239-1405
  • Fax: 347-640-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7003305N
License Number StateNY

VIII. Authorized Official

Name: MR. JOHN KEHOE
Title or Position: VP OF FINANCE
Credential:
Phone: 718-239-1405