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General NPI Number Information
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NPI Number | 1801070172
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Entity Type | Organization
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Legal Business Name | MEDFORD HAMLET, LLC
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 1529 N OCEAN AVE
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City | MEDFORD
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State | NY
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Zip | 11763-3556
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Country | US
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Telephone | 631-289-0622
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Fax |
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Provider Business Mailing Address
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Address Line | 1529 N OCEAN AVE
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City | MEDFORD
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State | NY
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Zip | 11763-3556
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Country | US
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Telephone | 631-289-0622
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MICHAEL J BENENSON
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Credential |
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Telephone | 631-289-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 700-F-921
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License Number State | NY
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