Healthcare Provider Details

I. General information

NPI: 1982244935
Provider Name (Legal Business Name): SOUTH COUNTY SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 OAK HILL RD
NORTH KINGSTOWN RI
02852-7205
US

IV. Provider business mailing address

1195 RAILROAD AVE
HEWLETT NY
11557-2316
US

V. Phone/Fax

Practice location:
  • Phone: 646-275-4510
  • Fax:
Mailing address:
  • Phone: 646-275-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHIMON IDELS
Title or Position: COO
Credential: LNHA
Phone: 917-565-7391