Provider Demographics
NPI:1245729847
Name:NASSAU HEALTHCARE CORPORATION
Entity type:Organization
Organization Name:NASSAU HEALTHCARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVANAGH-LANTIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-572-5135
Mailing Address - Street 1:2201 HEMPSTEAD TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-296-7450
Mailing Address - Fax:516-296-7376
Practice Address - Street 1:875 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553
Practice Address - Country:US
Practice Address - Phone:516-572-1400
Practice Address - Fax:516-296-7376
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NASSAU HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2950303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility