Provider Demographics
NPI:1235187964
Name:NESCONSET NURSING CENTER, LLC
Entity Type:Organization
Organization Name:NESCONSET NURSING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:RANIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-361-8800
Mailing Address - Street 1:100 SOUTHERN BLVD.
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1797
Mailing Address - Country:US
Mailing Address - Phone:631-361-8800
Mailing Address - Fax:631-361-9528
Practice Address - Street 1:100 SOUTHERN BLVD.
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1797
Practice Address - Country:US
Practice Address - Phone:631-361-8800
Practice Address - Fax:631-361-9528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00848733Medicaid
NY00848751Medicaid
NY335674Medicare Oscar/Certification
NY00848733Medicaid