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NPI Code Detail

MEDICARE: CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER, INC.

MEDICARE: CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER, INC.
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
1314000000XSkilled Nursing Facility7004305NNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417952417
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER, INC.
Provider Business Mailing Address
First Line : 25 FANNING ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-5307
Country : US
Telephone Number : 718-289-7900
Fax Number : 718-289-7028
Provider Business Practice Location Address
First Line : 25 FANNING ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-5307
Country : US
Telephone Number : 718-289-7900
Fax Number : 718-289-7028
Authorized Official
Title or Position : ADMINISTRATOR
Name : MS. LORRI ANN SCULLIN-SENK
Credential : LNHA
Telephone Number : 718-289-7890
Provider Enumeration Date : 06/16/2005
Last Update Date : 07/22/2014

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