Provider Demographics
NPI:1225332091
Name:SG SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:SG SENIOR LIVING, LLC
Other - Org Name:ATRIA ON ROSLYN HARBOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-779-7608
Mailing Address - Street 1:100 LANDING RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1102
Mailing Address - Country:US
Mailing Address - Phone:516-626-6900
Mailing Address - Fax:
Practice Address - Street 1:100 LANDING RD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1102
Practice Address - Country:US
Practice Address - Phone:516-626-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SG SENIOR LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility