MEDICARE: OCEANVIEW MANOR HOME FOR ADULTS, 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
1	310400000X	Assisted Living Facility	3011L001	NY

General Provider Information

NPI Number	:	1780014886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEANVIEW MANOR HOME FOR ADULTS, INC.

Provider Business Mailing Address
First Line	:	3010 W 33RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 W 33RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1404
Country	:	US
Telephone Number	:	718-996-1500
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LISA VIDER
Credential	:
Telephone Number	:	718-996-1500

Provider Enumeration Date	:	11/26/2013
Last Update Date	:	11/26/2013

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