Provider Demographics
NPI:1326117045
Name:PARK TERRACE CARE CENTER INC
Entity Type:Organization
Organization Name:PARK TERRACE CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:718-592-9200
Mailing Address - Street 1:59-20 VAN DOREN ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11368
Mailing Address - Country:US
Mailing Address - Phone:718-592-9200
Mailing Address - Fax:718-592-9851
Practice Address - Street 1:59-20 VAN DOREN ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:718-592-9200
Practice Address - Fax:718-592-9851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003374N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00311028Medicaid
NY00311028Medicaid