Provider Demographics
NPI:1790772242
Name:SHEEPSHEAD NURSING AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:SHEEPSHEAD NURSING AND REHABILITATION CENTER LLC
Other - Org Name:HARBOR SITE PARTNERSHIP OLGA LIPSHITZ GEN PTR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-646-5700
Mailing Address - Street 1:2840 KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1112
Mailing Address - Country:US
Mailing Address - Phone:718-646-5700
Mailing Address - Fax:718-646-3499
Practice Address - Street 1:2840 KNAPP ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1112
Practice Address - Country:US
Practice Address - Phone:718-646-5700
Practice Address - Fax:718-646-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY335677Medicare Oscar/Certification