Provider Demographics
NPI:1457342206
Name:MMR CARE CORP
Entity Type:Organization
Organization Name:MMR CARE CORP
Other - Org Name:DALEVIEW CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHANIWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:516-694-9800
Mailing Address - Street 1:574 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-7407
Mailing Address - Country:US
Mailing Address - Phone:516-694-9800
Mailing Address - Fax:516-694-6496
Practice Address - Street 1:574 FULTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-7407
Practice Address - Country:US
Practice Address - Phone:516-694-9800
Practice Address - Fax:516-694-6496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5150302N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01719626Medicaid
NY5150302OtherOPERATING CERTIFICATE
NY0524OtherPFI NUMBER
NY01719626Medicaid
NY1262400001Medicare NSC