Provider Demographics
NPI:1184797342
Name:FORT TRYON REHABILITATION & HEALTH CARE FACILITY LLC
Entity type:Organization
Organization Name:FORT TRYON REHABILITATION & HEALTH CARE FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KARASH
Authorized Official - Suffix:
Authorized Official - Credentials:CNHA
Authorized Official - Phone:212-543-6400
Mailing Address - Street 1:801 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3802
Mailing Address - Country:US
Mailing Address - Phone:212-543-6400
Mailing Address - Fax:212-543-6419
Practice Address - Street 1:801 W 190TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040
Practice Address - Country:US
Practice Address - Phone:212-543-6400
Practice Address - Fax:212-543-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002359N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310256Medicaid
NY7002359NOtherOPERATING CERTIFICATE
NY00310256Medicaid