MEDICARE: THE MEADOWS AT SUNBURY FOR NURSING AND REHABILITATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1215470554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MEADOWS AT SUNBURY FOR NURSING AND REHABILITATION LLC

Provider Business Mailing Address
First Line	:	99 W HAWTHORNE AVE
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-6163
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 MARKET ST
Second Line	:
City	:	SUNBURY
State	:	PA
Zip	:	17801-2403
Country	:	US
Telephone Number	:	570-286-6922
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	AKIVA GLATZER
Credential	:
Telephone Number	:	516-505-0000

Provider Enumeration Date	:	11/18/2016
Last Update Date	:	12/28/2016

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