Provider Demographics
NPI:1174997316
Name:CARMI MANOR REHABILITATION AND NURSING CENTER LLC
Entity type:Organization
Organization Name:CARMI MANOR REHABILITATION AND NURSING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BORUCH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-497-0440
Mailing Address - Street 1:26 FIREMENS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 W WEBB ST
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1668
Practice Address - Country:US
Practice Address - Phone:618-382-7270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-28
Last Update Date:2015-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
14-6124OtherMEDICARE ID