Provider Demographics
NPI:1497716534
Name:NASSAU HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:NASSAU HEALTH CARE CORPORATION
Other - Org Name:A. HOLLY PATTERSON EXTENDED CARE FACILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-572-5779
Mailing Address - Street 1:2201 HEMPSTEAD TPKE
Mailing Address - Street 2:ATTN: FINANCE DEPARTMENT
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1859
Mailing Address - Country:US
Mailing Address - Phone:516-572-6713
Mailing Address - Fax:
Practice Address - Street 1:875 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3038
Practice Address - Country:US
Practice Address - Phone:516-572-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2950302N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0378703Medicaid
NY0378703Medicaid
NY335023Medicare ID - Type Unspecified