Provider Demographics
NPI:1083602890
Name:SAINT JOACHIM & ANNE NURSING AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:SAINT JOACHIM & ANNE NURSING AND REHABILITATION CENTER
Other - Org Name:SAINTS JOACHIM & ANNE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO-AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTTAVIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-722-6105
Mailing Address - Street 1:2720 SURF AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1913
Mailing Address - Country:US
Mailing Address - Phone:718-714-4800
Mailing Address - Fax:718-266-1743
Practice Address - Street 1:2720 SURF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1913
Practice Address - Country:US
Practice Address - Phone:718-714-4800
Practice Address - Fax:718-266-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01220915Medicaid
NY335748Medicare ID - Type Unspecified