MEDICARE: LAFAYETTE CARE 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	:	1659090363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAFAYETTE CARE LLC

Provider Business Mailing Address
First Line	:	1166 E 27TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4621
Country	:	US
Telephone Number	:	347-609-3119
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 LAFAYETTE ST
Second Line	:
City	:	MARBLEHEAD
State	:	MA
Zip	:	01945-1939
Country	:	US
Telephone Number	:	781-631-4535
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. SETH PROBST
Credential	:
Telephone Number	:	781-631-4535

Provider Enumeration Date	:	08/25/2022
Last Update Date	:	01/16/2025

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