Provider Demographics
NPI:1225401987
Name:WILLOWBROOK SNF MANAGEMENT LLC
Entity Type:Organization
Organization Name:WILLOWBROOK SNF MANAGEMENT LLC
Other - Org Name:WILLOWBROOK RESIDENCE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-596-5222
Mailing Address - Street 1:1981 MARCUS AVE
Mailing Address - Street 2:SUITE C129
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2060
Mailing Address - Country:US
Mailing Address - Phone:516-596-5222
Mailing Address - Fax:516-775-3299
Practice Address - Street 1:13631 ARDFIELD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5837
Practice Address - Country:US
Practice Address - Phone:281-955-9572
Practice Address - Fax:281-955-1597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility