Provider Demographics
NPI:1780994046
Name:JOPAL AT ST. JAMES LLC
Entity type:Organization
Organization Name:JOPAL AT ST. JAMES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PASQUALE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBENEDICTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-630-0314
Mailing Address - Street 1:273 MORICHES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2117
Mailing Address - Country:US
Mailing Address - Phone:631-862-8990
Mailing Address - Fax:631-862-6792
Practice Address - Street 1:273 MORICHES RD
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2117
Practice Address - Country:US
Practice Address - Phone:631-862-8990
Practice Address - Fax:631-862-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5157308N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00312029Medicaid
335739Medicare PIN