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NPI Code Detail

MEDICARE: GRAND SOUTH POINT LLC

MEDICARE: GRAND SOUTH POINT 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1528530805
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRAND SOUTH POINT LLC
Provider Business Mailing Address
First Line : 1720 WHITESTONE EXPY STE 500
Second Line :
City : WHITESTONE
State : NY
Zip : 11357-3021
Country : US
Telephone Number : 718-215-6000
Fax Number :
Provider Business Practice Location Address
First Line : 1 LONG BEACH RD
Second Line :
City : ISLAND PARK
State : NY
Zip : 11558-2254
Country : US
Telephone Number : 718-215-6000
Fax Number :
Authorized Official
Title or Position : CFO
Name : MR. ERIC J ROGERS
Credential :
Telephone Number : 718-215-6000
Provider Enumeration Date : 12/26/2018
Last Update Date : 12/26/2018

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Directions to “GRAND SOUTH POINT LLC ” Practice Location

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