Provider Demographics
NPI:1790982635
Name:LONG ISLAND HEBREW LIVING CENTER
Entity Type:Organization
Organization Name:LONG ISLAND HEBREW LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETRIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-327-2700
Mailing Address - Street 1:431 BEACH 20TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-3621
Mailing Address - Country:US
Mailing Address - Phone:718-327-2700
Mailing Address - Fax:718-327-2223
Practice Address - Street 1:431 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3621
Practice Address - Country:US
Practice Address - Phone:718-327-2700
Practice Address - Fax:718-327-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9452L001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01452359Medicaid