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General NPI Number Information
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NPI Number | 1679563464
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Entity Type | Organization
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Legal Business Name | NURSING CARE CENTER AT MEDFORD INC
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 3115 HORSEBLOCK RD
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City | MEDFORD
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State | NY
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Zip | 11763
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Country | US
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Telephone | 631-730-3016
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Fax | 631-730-3131
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Provider Business Mailing Address
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Address Line | 3115 HORSEBLOCK RD
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City | MEDFORD
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State | NY
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Zip | 11763
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Country | US
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Telephone | 631-730-3016
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Fax | 631-730-3131
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Authorized Official
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Title or Position | CONTROLLER
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Name | MICHAEL F LEAHY
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Credential |
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Telephone | 631-730-3016
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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 | 5151319N
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License Number State | NY
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