Healthcare Provider Details

I. General information

NPI: 1881067544
Provider Name (Legal Business Name): WEBSTER SNF MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W TEXAS AVE
WEBSTER TX
77598-3259
US

IV. Provider business mailing address

1981 MARCUS AVE SUITE C129
NEW HYDE PARK NY
11042-2060
US

V. Phone/Fax

Practice location:
  • Phone: 281-332-3496
  • Fax: 281-332-8047
Mailing address:
  • Phone: 516-596-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELIE DEITSCH
Title or Position: MANAGER
Credential:
Phone: 516-596-5222