Provider Demographics
NPI:1942544903
Name:GRAND MANOR NURSING HOME
Entity Type:Organization
Organization Name:GRAND MANOR NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:NADEEN
Authorized Official - Middle Name:MAJORIE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-932-5811
Mailing Address - Street 1:922 E 222ND ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1018
Mailing Address - Country:US
Mailing Address - Phone:347-932-5811
Mailing Address - Fax:
Practice Address - Street 1:922 E 222ND ST
Practice Address - Street 2:APT 1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-1018
Practice Address - Country:US
Practice Address - Phone:347-932-5811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY553366273R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit