Healthcare Provider Details

I. General information

NPI: 1205166816
Provider Name (Legal Business Name): PARK MANOR ACQUISITION II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DUNNING RD
MIDDLETOWN NY
10940-2243
US

IV. Provider business mailing address

121 DUNNING RD
MIDDLETOWN NY
10940-2243
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-0801
  • Fax: 845-343-1838
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LIZER JOZEFOVIC
Title or Position: MEMBER
Credential:
Phone: 845-343-0801