Provider Demographics
NPI:1053665240
Name:ERNC OPERATING, LLC
Entity Type:Organization
Organization Name:ERNC OPERATING, LLC
Other - Org Name:THE REHABILITATION AND NURSING CENTER AT EVERETT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:YEHUDAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-882-5335
Mailing Address - Street 1:20 WOOD CT
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-3108
Mailing Address - Country:US
Mailing Address - Phone:914-597-7600
Mailing Address - Fax:914-597-7623
Practice Address - Street 1:289 ELM ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5228
Practice Address - Country:US
Practice Address - Phone:617-387-6560
Practice Address - Fax:617-387-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225300Medicare Oscar/Certification