Healthcare Provider Details

I. General information

NPI: 1619339363
Provider Name (Legal Business Name): SUMMIT PARK AT FRIEDWALD CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SANITORIUM RD, BLDG A, 3RD FLOOR
POMONA NY
10970
US

IV. Provider business mailing address

475 NEW HEMPSTEAD RD
NEW CITY NY
10956-1000
US

V. Phone/Fax

Practice location:
  • Phone: 845-243-5000
  • Fax: 845-243-5001
Mailing address:
  • Phone: 845-678-2000
  • Fax: 845-678-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4350305N
License Number StateNY

VIII. Authorized Official

Name: MR. STEVE STAUM
Title or Position: ADMINISTRATOR
Credential:
Phone: 845-678-2000