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General NPI Number Information
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NPI Number | 1245324078
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Entity Type | Organization
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Legal Business Name | PETITE FLEUR NURSING HOME
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 BROADWAY AVENUE
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City | SAYVILLE
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State | NY
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Zip | 11782-1628
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Country | US
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Telephone | 631-567-9300
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Fax | 631-567-6929
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Provider Business Mailing Address
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Address Line | 300 BROADWAY AVENUE
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City | SAYVILLE
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State | NY
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Zip | 11782-1628
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Country | US
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Telephone | 631-567-9300
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Fax | 631-567-6929
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | THERESA A SANTMANN
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Credential |
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Telephone | 631-567-9300
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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 | 5154311N
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License Number State | NY
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