Provider Demographics
NPI:1235122722
Name:VALLEY VIEW MANOR LLC
Entity Type:Organization
Organization Name:VALLEY VIEW MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, FISCAL OVERSIGHTQ
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEWIRTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-588-8379
Mailing Address - Street 1:40 PARK ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1556
Mailing Address - Country:US
Mailing Address - Phone:607-334-9931
Mailing Address - Fax:607-336-4520
Practice Address - Street 1:40 PARK ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1556
Practice Address - Country:US
Practice Address - Phone:607-334-9931
Practice Address - Fax:607-336-4520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0824303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00373088Medicaid
NY00373088Medicaid