Provider Demographics
NPI:1114631306
Name:WIND RIVER SNF OPERATIONS, LLC
Entity Type:Organization
Organization Name:WIND RIVER SNF OPERATIONS, LLC
Other - Org Name:WIND RIVER REHABILITATION AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:YENOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-333-0910
Mailing Address - Street 1:1777 AVENUE OF THE STATES STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4779
Mailing Address - Country:US
Mailing Address - Phone:732-366-8300
Mailing Address - Fax:732-523-5312
Practice Address - Street 1:1002 FOREST DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2918
Practice Address - Country:US
Practice Address - Phone:307-856-9471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty