Provider Demographics
NPI:1619413572
Name:SANDALWOOD OPERATING LLC
Entity Type:Organization
Organization Name:SANDALWOOD OPERATING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR
Authorized Official - Prefix:
Authorized Official - First Name:YOSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-592-3604
Mailing Address - Street 1:199 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 S BEACH ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-6204
Practice Address - Country:US
Practice Address - Phone:386-258-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDALWOOD HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility