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General NPI Number Information
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NPI Number | 1316765878
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Entity Type | Organization
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Legal Business Name | 300 PEARL STREET OPCO LLC
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 300 PEARL ST
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City | BURLINGTON
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State | VT
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Zip | 05401-8531
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Country | US
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Telephone | 802-658-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 290 CENTRAL AVE STE 107
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City | LAWRENCE
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State | NY
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Zip | 11559-8507
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Country | US
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Telephone | 516-430-5735
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Fax | 781-729-3817
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Authorized Official
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Title or Position | CFO
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Name | YEHUDA A RAINDEL
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Credential |
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Telephone | 516-430-5735
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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 |
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License Number State |
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