Provider Demographics
NPI:1245785310
Name:GARDEN REHAB AND HEALTH CARE AT VICTORIAN VILLAGE LLC
Entity Type:Organization
Organization Name:GARDEN REHAB AND HEALTH CARE AT VICTORIAN VILLAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMZEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-426-6961
Mailing Address - Street 1:920 THURBER DR W
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 W HAWTHORNE AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-6163
Practice Address - Country:US
Practice Address - Phone:516-505-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1453N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility