Provider Demographics
NPI:1073853560
Name:VK EAST BRIDGEWATER, LLC
Entity Type:Organization
Organization Name:VK EAST BRIDGEWATER, LLC
Other - Org Name:SACHEM CENTER FOR HEALTH & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-705-4802
Mailing Address - Street 1:46 STAUDERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:66 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1913
Practice Address - Country:US
Practice Address - Phone:508-378-7227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
225322Medicare Oscar/Certification