Healthcare Provider Details

I. General information

NPI: 1255327078
Provider Name (Legal Business Name): SILVER LAKE SPECIALIZED REHABILITATION & CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CASTLETON AVE
STATEN ISLAND NY
10301-2709
US

IV. Provider business mailing address

275 CASTLETON AVE
STATEN ISLAND NY
10301-2709
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-7800
  • Fax: 718-448-8385
Mailing address:
  • Phone: 718-447-7800
  • Fax: 718-448-8385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7004323N
License Number StateNY

VIII. Authorized Official

Name: MICHAEL KRAUS
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 718-447-7800