Provider Demographics
NPI:1104524545
Name:NORTHSIDE SNF OPERATIONS LLC
Entity type:Organization
Organization Name:NORTHSIDE SNF OPERATIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-995-1700
Mailing Address - Street 1:700 HUTCHINS AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-1876
Mailing Address - Country:US
Mailing Address - Phone:256-543-7101
Mailing Address - Fax:256-543-2367
Practice Address - Street 1:700 HUTCHINS AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-1876
Practice Address - Country:US
Practice Address - Phone:256-543-7101
Practice Address - Fax:256-543-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility