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General NPI Number Information
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NPI Number | 1194893719
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Entity Type | Organization
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Legal Business Name | KENNETH GAUL II, LLC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 6 FROWEIN RD
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City | CENTER MORICHES
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State | NY
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Zip | 11934-1604
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Country | US
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Telephone | 631-878-4400
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Fax | 631-878-6865
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Provider Business Mailing Address
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Address Line | 6 FROWEIN RD
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City | CENTER MORICHES
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State | NY
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Zip | 11934-1604
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Country | US
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Telephone | 631-878-4400
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Fax | 631-878-6865
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS MADELINE C BUTLER
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Credential | LNHA
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Telephone | 631-878-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 5151313N
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License Number State | NY
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