Provider Demographics
NPI:1013621309
Name:THE DALLES SNF OPERATIONS, LLC
Entity Type:Organization
Organization Name:THE DALLES SNF OPERATIONS, LLC
Other - Org Name:THE DALLES HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:YENOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-769-8877
Mailing Address - Street 1:1777 AVENUE OF THE STATES STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4779
Mailing Address - Country:US
Mailing Address - Phone:732-366-8300
Mailing Address - Fax:723-523-5312
Practice Address - Street 1:1023 W 25TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1251
Practice Address - Country:US
Practice Address - Phone:541-298-5158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility