MEDICARE: MARCUS GARVEY RESIDENTIAL REHAB PAVILION

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

Other Identifiers

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

General Provider Information

NPI Number	:	1831159664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCUS GARVEY RESIDENTIAL REHAB PAVILION

Provider Business Mailing Address
First Line	:	810 SAINT MARKS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-1420
Country	:	US
Telephone Number	:	718-467-7300
Fax Number	:	718-467-7878

Provider Business Practice Location Address
First Line	:	810 SAINT MARKS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-1420
Country	:	US
Telephone Number	:	718-467-7300
Fax Number	:	718-467-7878

Authorized Official
Title or Position	:	CFO
Name	:	DARNELL J COY
Credential	:
Telephone Number	:	718-467-7300

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	05/04/2010

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