Provider Demographics
NPI:1093708646
Name:ROCKVILLE SKILLED NURSING & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:ROCKVILLE SKILLED NURSING & REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-536-8000
Mailing Address - Street 1:50 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3608
Mailing Address - Country:US
Mailing Address - Phone:516-536-8000
Mailing Address - Fax:
Practice Address - Street 1:50 MAINE AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3608
Practice Address - Country:US
Practice Address - Phone:516-536-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0517OtherPFI
NY01934812Medicaid
NY2909304NOtherOPERATING #
NY01934812Medicaid