Provider Demographics
NPI:1831147214
Name:FRIEDWALD CENTER FOR REHABILITATION AND NURSING, LLC
Entity Type:Organization
Organization Name:FRIEDWALD CENTER FOR REHABILITATION AND NURSING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUM
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:845-678-2000
Mailing Address - Street 1:475 NEW HEMPSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1000
Mailing Address - Country:US
Mailing Address - Phone:845-678-2000
Mailing Address - Fax:
Practice Address - Street 1:475 NEW HEMPSTEAD RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1000
Practice Address - Country:US
Practice Address - Phone:845-678-2000
Practice Address - Fax:845-678-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4350305N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00312845Medicaid
NY00312845Medicaid
NY5199740001Medicare NSC