Healthcare Provider Details

I. General information

NPI: 1629420187
Provider Name (Legal Business Name): WEST LEDGE OP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MAIN ST
PEEKSKILL NY
10566-6816
US

IV. Provider business mailing address

2000 MAIN ST
PEEKSKILL NY
10566-6816
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-8400
  • Fax:
Mailing address:
  • Phone: 914-737-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5901308N
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARK FRIEDMAN
Title or Position: OWNER
Credential:
Phone: 201-731-1700