Healthcare Provider Details

I. General information

NPI: 1760027544
Provider Name (Legal Business Name): OVERLOOK EDEN OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ROCK AVE
PASCOAG RI
02859-3220
US

IV. Provider business mailing address

3118 QUENTIN RD
BROOKLYN NY
11234-4249
US

V. Phone/Fax

Practice location:
  • Phone: 718-975-4714
  • Fax:
Mailing address:
  • Phone:
  • 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: LOUIS GELLIS
Title or Position: OWNER
Credential:
Phone: 917-533-7241