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General NPI Number Information
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NPI Number | 1255327078
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Entity Type | Organization
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Legal Business Name | SILVER LAKE SPECIALIZED REHABILITATION & CARE CENTER, LLC
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 275 CASTLETON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10301-2709
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Country | US
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Telephone | 718-447-7800
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Fax | 718-448-8385
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Provider Business Mailing Address
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Address Line | 275 CASTLETON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10301-2709
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Country | US
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Telephone | 718-447-7800
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Fax | 718-448-8385
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MICHAEL KRAUS
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Credential | LNHA
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Telephone | 718-447-7800
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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 | 7004323N
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License Number State | NY
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