MEDICARE: THE BAY AT ELMWOOD HEALTH AND REHABILITATION CENTER, 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	:	1265961585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BAY AT ELMWOOD HEALTH AND REHABILITATION CENTER, LLC

Provider Business Mailing Address
First Line	:	165 N VILLAGE AVE STE 126
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-3763
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1881 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-3041
Country	:	US
Telephone Number	:	313-922-1600
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MENACHEM RUVEL
Credential	:
Telephone Number	:	516-605-9800

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	03/26/2018

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