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NPI Code Detail

MEDICARE: HARBORVIEW KING CITY LLC

MEDICARE: HARBORVIEW KING CITY 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 : 1669937694
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARBORVIEW KING CITY LLC
Provider Business Mailing Address
First Line : 548 CEDARWOOD DR
Second Line :
City : CEDARHURST
State : NY
Zip : 11516-1010
Country : US
Telephone Number : 917-804-1661
Fax Number :
Provider Business Practice Location Address
First Line : 300 W FAIRVIEW ST
Second Line :
City : KING CITY
State : MO
Zip : 64463-9606
Country : US
Telephone Number : 660-535-4325
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : CHAIM LEIBOWITZ
Credential :
Telephone Number : 917-804-1661
Provider Enumeration Date : 02/04/2019
Last Update Date : 02/04/2019

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Directions to “HARBORVIEW KING CITY LLC ” Practice Location

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