Provider Demographics
NPI:1861486011
Name:RIVER MANOR CORP.
Entity Type:Organization
Organization Name:RIVER MANOR CORP.
Other - Org Name:RIVER MANOR CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-240-3100
Mailing Address - Street 1:611 E 103RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-2501
Mailing Address - Country:US
Mailing Address - Phone:718-240-3100
Mailing Address - Fax:718-272-3160
Practice Address - Street 1:611 E 103RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-2501
Practice Address - Country:US
Practice Address - Phone:718-240-3100
Practice Address - Fax:718-272-3160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001378N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY312703Medicaid
NY00312703Medicaid
NY335720Medicare Oscar/Certification
NY312703Medicaid