Provider Demographics
NPI:1821084195
Name:MANHATTANVILLE SBV LLC
Entity Type:Organization
Organization Name:MANHATTANVILLE SBV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-601-8400
Mailing Address - Street 1:311 W 231ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3804
Mailing Address - Country:US
Mailing Address - Phone:718-601-8400
Mailing Address - Fax:718-601-5038
Practice Address - Street 1:311 W 231ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3804
Practice Address - Country:US
Practice Address - Phone:718-601-8400
Practice Address - Fax:718-601-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY700355N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01101615Medicaid
NY33-5695Medicare ID - Type Unspecified