Provider Demographics
NPI:1619339363
Name:SUMMIT PARK AT FRIEDWALD CARE, LLC
Entity Type:Organization
Organization Name:SUMMIT PARK AT FRIEDWALD CARE, LLC
Other - Org Name:FRIEDWALD ADULT DAY HEALTH CARE AT SUMMIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-678-2000
Mailing Address - Street 1:475 NEW HEMPSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1000
Mailing Address - Country:US
Mailing Address - Phone:845-678-2000
Mailing Address - Fax:845-678-2100
Practice Address - Street 1:50 SANITORIUM RD, BLDG A, 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:845-243-5000
Practice Address - Fax:845-243-5001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRIEDWALD CENTER FOR REHABILITATION AND NURSING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4350305N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility