Provider Demographics
NPI:1558877670
Name:EAST HIALEAH MANOR LLC
Entity Type:Organization
Organization Name:EAST HIALEAH MANOR LLC
Other - Org Name:EAST HIALEAH PLACE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-548-7617
Mailing Address - Street 1:22 REGAL DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-1202
Mailing Address - Country:US
Mailing Address - Phone:914-548-7617
Mailing Address - Fax:914-633-1620
Practice Address - Street 1:3051 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3260
Practice Address - Country:US
Practice Address - Phone:914-548-7617
Practice Address - Fax:914-633-1620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGAL HEALTHCARE ALF HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility