Provider Demographics
NPI:1568867562
Name:KENNEDY PAVILION RH I, LLC
Entity Type:Organization
Organization Name:KENNEDY PAVILION RH I, LLC
Other - Org Name:THE PAVILION AT QUEENS FOR REHABILITATION AND NURSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:917-626-5894
Mailing Address - Street 1:3617 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5931
Mailing Address - Country:US
Mailing Address - Phone:718-961-4300
Mailing Address - Fax:
Practice Address - Street 1:3617 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5931
Practice Address - Country:US
Practice Address - Phone:718-961-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility