MEDICARE: GRANDELL REHAB & NURSING CTR 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	314000000X	Skilled Nursing Facility	0381774	NY

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	:	1851486914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDELL REHAB & NURSING CTR INC

Provider Business Mailing Address
First Line	:	645 WEST BROADWAY
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2902
Country	:	US
Telephone Number	:	516-889-1100
Fax Number	:	516-431-0398

Provider Business Practice Location Address
First Line	:	645 WEST BROADWAY
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2902
Country	:	US
Telephone Number	:	516-889-1100
Fax Number	:	516-431-0398

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	MR. MOISHE HELLER
Credential	:	LNHA
Telephone Number	:	516-889-1100

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	01/12/2012

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