Provider Demographics
NPI:1114141140
Name:SPLIT ROCK REHABILITATION & HEALTH CARE CENTER, LLC
Entity Type:Organization
Organization Name:SPLIT ROCK REHABILITATION & HEALTH CARE CENTER, LLC
Other - Org Name:BRIAH HOME CARE/SPLIT ROCK LTHHCP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL PROJECTS
Authorized Official - Prefix:MR
Authorized Official - First Name:AJ
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-798-8900
Mailing Address - Street 1:3525 BAYCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-5001
Mailing Address - Country:US
Mailing Address - Phone:718-798-8900
Mailing Address - Fax:
Practice Address - Street 1:3525 BAYCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-5001
Practice Address - Country:US
Practice Address - Phone:718-798-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY700911L251E00000X
NY7000612251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01977302Medicaid
NY337416Medicare Oscar/Certification