=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659291599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LINDSIDE SNF LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2026
-----------------------------------------------------
Last Update Date | 07/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10797 SENECA TRL S
-----------------------------------------------------
City | LINDSIDE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 24951-7345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-753-4332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10797 SENECA TRL S
-----------------------------------------------------
City | LINDSIDE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 24951-7345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-753-4332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | ROBERT COHEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 347-463-2399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------