Healthcare Provider Details

I. General information

NPI: 1861495202
Provider Name (Legal Business Name): WOODMERE REHABILITATION AND HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 FRANKLIN PLACE
WOODMERE NY
11598
US

IV. Provider business mailing address

121 FRANKLIN PLACE
WOODMERE NY
11598
US

V. Phone/Fax

Practice location:
  • Phone: 516-374-9300
  • Fax: 516-374-1786
Mailing address:
  • Phone: 516-374-9300
  • Fax: 516-374-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2950315N
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StateNY

VIII. Authorized Official

Name: DEBORAH ANN FLACK
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 516-374-9300