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General NPI Number Information
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NPI Number | 1205822400
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Entity Type | Organization
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Legal Business Name | OUR LADY OF CONSOLATION GERIATRIC CARE CENTER
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 111 BEACH DR
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City | WEST ISLIP
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State | NY
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Zip | 11795-4929
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Country | US
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Telephone | 631-587-1600
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Fax | 631-587-3263
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Provider Business Mailing Address
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Address Line | 111 BEACH DR
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City | WEST ISLIP
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State | NY
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Zip | 11795-4929
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Country | US
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Telephone | 631-587-1600
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Fax | 631-587-3263
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Authorized Official
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Title or Position | COO & SVP FINANCE
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Name | JOSEPH O'DOHERTY
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Credential |
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Telephone | 631-465-6568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 5154319N
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License Number State | NY
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