Provider Demographics
NPI:1003829003
Name:PARK GARDENS REHABILITATION AND NURSING CENTER LONG TERM HOME HEALTH C
Entity Type:Organization
Organization Name:PARK GARDENS REHABILITATION AND NURSING CENTER LONG TERM HOME HEALTH C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-549-2200
Mailing Address - Street 1:6585 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2050
Mailing Address - Country:US
Mailing Address - Phone:718-549-2200
Mailing Address - Fax:718-549-5030
Practice Address - Street 1:6677B BROADWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1154
Practice Address - Country:US
Practice Address - Phone:718-543-0283
Practice Address - Fax:718-543-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPENDING251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY337432Medicare Oscar/Certification