Provider Demographics
NPI:1659819951
Name:AVALON GARDENS ADULT DAY HEALTH CARE
Entity Type:Organization
Organization Name:AVALON GARDENS ADULT DAY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-724-2200
Mailing Address - Street 1:7 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-724-1228
Mailing Address - Fax:631-724-8879
Practice Address - Street 1:7 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-724-1228
Practice Address - Fax:631-724-8879
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVALON GARDENS REHAB. & HCC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-07
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5157313N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02998209Medicaid