Provider Demographics
NPI:1437485935
Name:GARDENDALE SNF LLC
Entity Type:Organization
Organization Name:GARDENDALE SNF LLC
Other - Org Name:GARDENDALE REHABILITATION & NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ZEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-370-9063
Mailing Address - Street 1:2225 E RANDOL MILL RD
Mailing Address - Street 2:STE630
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-6315
Mailing Address - Country:US
Mailing Address - Phone:817-607-7400
Mailing Address - Fax:
Practice Address - Street 1:1521 E RUSK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-5505
Practice Address - Country:US
Practice Address - Phone:903-586-3626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
455517Medicare Oscar/Certification