Provider Demographics
NPI:1033697883
Name:GRAND MOHAWK VALLEY LLC
Entity Type:Organization
Organization Name:GRAND MOHAWK VALLEY LLC
Other - Org Name:THE GRAND REHABILITATION AND NURSING AT MOHAWK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-215-6000
Mailing Address - Street 1:1720 WHITESTONE EXPY STE 500
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3021
Mailing Address - Country:US
Mailing Address - Phone:718-215-6000
Mailing Address - Fax:
Practice Address - Street 1:99 6TH AVE
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-1527
Practice Address - Country:US
Practice Address - Phone:718-215-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility