Healthcare Provider Details

I. General information

NPI: 1164122990
Provider Name (Legal Business Name): WATERVIEW SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 ALGONQUIN RD
HAMPTON VA
23661-1605
US

IV. Provider business mailing address

265 E MERRICK RD STE 205
VALLEY STREAM NY
11580-6004
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9881
  • 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: JAKE HARTSTEIN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 757-722-9881