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General NPI Number Information
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NPI Number | 1457069270
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE MANOR HOME FOR ADULTS
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Dates
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Enumeration Date | 11/10/2022
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 1041 E 83RD ST
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City | BROOKLYN
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State | NY
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Zip | 11236-4225
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Country | US
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Telephone | 718-241-7035
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Fax |
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Provider Business Mailing Address
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Address Line | 2357 60TH ST
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City | BROOKLYN
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State | NY
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Zip | 11204-2689
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF SPECIAL PROJECTS
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Name | MS. JENNIFER GRAJALES
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Credential |
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Telephone | 347-988-4535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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