Provider Demographics
NPI:1336377324
Name:WESTCHESTER PARK LLC
Entity Type:Organization
Organization Name:WESTCHESTER PARK LLC
Other - Org Name:SANS SOUCI REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-596-1800
Mailing Address - Street 1:115 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2903
Mailing Address - Country:US
Mailing Address - Phone:914-423-9800
Mailing Address - Fax:914-965-3741
Practice Address - Street 1:115 PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2903
Practice Address - Country:US
Practice Address - Phone:914-423-9800
Practice Address - Fax:914-965-3741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTCHESTER PARK VENTURES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-29
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPENDING314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY308714Medicaid
NY335398Medicare Oscar/Certification