Provider Demographics
NPI:1417903816
Name:OAKWOOD OPERATING CO, LLC
Entity Type:Organization
Organization Name:OAKWOOD OPERATING CO, LLC
Other - Org Name:AFFINITY SKILLED LIVING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, FISCAL OVERSIGHT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEWIRTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-588-8379
Mailing Address - Street 1:305 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1652
Mailing Address - Country:US
Mailing Address - Phone:631-218-5900
Mailing Address - Fax:631-218-5905
Practice Address - Street 1:305 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1652
Practice Address - Country:US
Practice Address - Phone:631-218-5900
Practice Address - Fax:631-218-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5154323N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02339119Medicaid
NY02339119Medicaid