Provider Demographics
NPI:1477554723
Name:PARKSHORE HEALTHCARE LLC
Entity Type:Organization
Organization Name:PARKSHORE HEALTHCARE LLC
Other - Org Name:FOUR SEASONS NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-927-6300
Mailing Address - Street 1:1555 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4001
Mailing Address - Country:US
Mailing Address - Phone:718-927-6300
Mailing Address - Fax:718-272-2166
Practice Address - Street 1:1535 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4001
Practice Address - Country:US
Practice Address - Phone:718-927-6300
Practice Address - Fax:718-272-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001916L251E00000X
NY7001641251E00000X
NY7001385N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7001361NOtherSTATE OPERATING CERTF. #
NY02995779Medicaid
NY7001641OtherSTATE OPER CERT# CHHA
7001385NOtherSTATE OPERATING CERT #
NY00843485Medicaid
NY3227OtherPFI
7001916LOtherSTATE OPER CERT# LTHHCP
NY00843485Medicaid
NY335673Medicare Oscar/Certification