Healthcare Provider Details

I. General information

NPI: 1174510648
Provider Name (Legal Business Name): GOLDEN GATE REHABILITATION & HEALTH CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 BRADLEY AVE
STATEN ISLAND NY
10314-5166
US

IV. Provider business mailing address

191 BRADLEY AVE
STATEN ISLAND NY
10314-5166
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-8800
  • Fax: 718-494-4472
Mailing address:
  • Phone: 718-698-8800
  • Fax: 718-494-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7004315N
License Number StateNY

VIII. Authorized Official

Name: MARIA LORENZO
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 718-698-8800