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General NPI Number Information
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NPI Number | 1992856751
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Entity Type | Organization
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Legal Business Name | PROMENADE NURSING HOME, INC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 140 BEACH 114TH ST
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2405
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Country | US
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Telephone | 718-945-4600
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Fax | 718-634-8237
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Provider Business Mailing Address
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Address Line | 140 BEACH 114TH ST
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2405
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Country | US
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Telephone | 718-945-4600
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Fax | 718-634-8237
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Authorized Official
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Title or Position | ASSOCIATE ADMINISTRATOR
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Name | MR. PETER GROSS
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Credential |
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Telephone | 718-945-4600
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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 | 7003386N
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License Number State | NY
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