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General NPI Number Information
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NPI Number | 1982244935
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Entity Type | Organization
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Legal Business Name | SOUTH COUNTY SNF OPERATIONS LLC
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 740 OAK HILL RD
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-7205
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Country | US
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Telephone | 646-275-4510
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Fax |
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Provider Business Mailing Address
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Address Line | 1195 RAILROAD AVE
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City | HEWLETT
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State | NY
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Zip | 11557-2316
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Country | US
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Telephone | 646-275-4510
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Fax |
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Authorized Official
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Title or Position | COO
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Name | SHIMON IDELS
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Credential | LNHA
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Telephone | 917-565-7391
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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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