Provider Demographics
NPI:1619338266
Name:MAYBROOK-P BUTLER VALLEY OPCO, LLC
Entity Type:Organization
Organization Name:MAYBROOK-P BUTLER VALLEY OPCO, LLC
Other - Org Name:THE GARDENS AT BUTLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EPHRAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAHASKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-772-3668
Mailing Address - Street 1:34 LORD AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1324
Mailing Address - Country:US
Mailing Address - Phone:646-772-3668
Mailing Address - Fax:
Practice Address - Street 1:463 N HUNTER HWY
Practice Address - Street 2:
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222-2129
Practice Address - Country:US
Practice Address - Phone:570-788-4175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility