Provider Demographics
NPI:1598180028
Name:VALLEY STREAM OPERATOR LLC
Entity Type:Organization
Organization Name:VALLEY STREAM OPERATOR LLC
Other - Org Name:VALLEY STREAM REHABILITATION AND HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:NACHUM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROKEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-232-9217
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-0090
Mailing Address - Country:US
Mailing Address - Phone:732-606-5973
Mailing Address - Fax:732-608-2976
Practice Address - Street 1:94 SUMMER ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5761
Practice Address - Country:US
Practice Address - Phone:978-343-3530
Practice Address - Fax:732-608-2976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
225227Medicare Oscar/Certification