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General NPI Number Information
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NPI Number | 1760027544
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Entity Type | Organization
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Legal Business Name | OVERLOOK EDEN OPERATIONS, LLC
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Dates
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Enumeration Date | 11/15/2019
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 14 ROCK AVE
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City | PASCOAG
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State | RI
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Zip | 02859-3220
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Country | US
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Telephone | 718-975-4714
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Fax |
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Provider Business Mailing Address
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Address Line | 3118 QUENTIN RD
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City | BROOKLYN
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State | NY
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Zip | 11234-4249
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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 | OWNER
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Name | LOUIS GELLIS
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Credential |
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Telephone | 917-533-7241
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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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