Healthcare Provider Details

I. General information

NPI: 1144044645
Provider Name (Legal Business Name): WYNCOTE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 FERNBROOK AVE
WYNCOTE PA
19095-1532
US

IV. Provider business mailing address

1166 E 27TH ST
BROOKLYN NY
11210-4621
US

V. Phone/Fax

Practice location:
  • Phone: 347-773-6070
  • Fax:
Mailing address:
  • Phone: 347-773-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: SETH PROBST
Title or Position: MANAGER
Credential:
Phone: 347-773-6070