Provider Demographics
NPI:1366820342
Name:CLIFFSIDE NURSING HOME INC
Entity Type:Organization
Organization Name:CLIFFSIDE NURSING HOME INC
Other - Org Name:CLIFFSIDE REHABILITATION & RESIDENTIAL HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-886-0700
Mailing Address - Street 1:11919 GRAHAM CT
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1047
Mailing Address - Country:US
Mailing Address - Phone:718-886-0700
Mailing Address - Fax:
Practice Address - Street 1:11919 GRAHAM CT
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1047
Practice Address - Country:US
Practice Address - Phone:718-886-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003380N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY309504Medicaid
NY309504Medicaid