Provider Demographics
NPI:1316361298
Name:JSSG HEALTHCARE LLC.
Entity Type:Organization
Organization Name:JSSG HEALTHCARE LLC.
Other - Org Name:FIDDLERS GREEN MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-621-5400
Mailing Address - Street 1:168 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1016
Mailing Address - Country:US
Mailing Address - Phone:716-592-4781
Mailing Address - Fax:
Practice Address - Street 1:168 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1016
Practice Address - Country:US
Practice Address - Phone:716-592-4781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1427303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00475214Medicaid
NY335457001Medicare Oscar/Certification