Provider Demographics
NPI:1457358814
Name:MEADOWBROOK CARE CENTER, INC.
Entity Type:Organization
Organization Name:MEADOWBROOK CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:PELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-377-8200
Mailing Address - Street 1:320 W MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3248
Mailing Address - Country:US
Mailing Address - Phone:516-377-8200
Mailing Address - Fax:516-377-8275
Practice Address - Street 1:320 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3248
Practice Address - Country:US
Practice Address - Phone:516-377-8200
Practice Address - Fax:516-377-8275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2904301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01678000Medicaid
NY1189440001Medicare NSC
NY335796Medicare Oscar/Certification