Provider Demographics
NPI:1568539609
Name:EAST NORTHPORT RESIDENTIAL HEALTH CARE FACILITY, INC
Entity Type:Organization
Organization Name:EAST NORTHPORT RESIDENTIAL HEALTH CARE FACILITY, INC
Other - Org Name:HUNTINGTON HILL CENTER FOR HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-439-3000
Mailing Address - Street 1:400 S SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3229
Mailing Address - Country:US
Mailing Address - Phone:631-439-3000
Mailing Address - Fax:631-439-3001
Practice Address - Street 1:400 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3229
Practice Address - Country:US
Practice Address - Phone:631-439-3000
Practice Address - Fax:631-439-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5153309N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01987200Medicaid
NY335818Medicare ID - Type Unspecified