Provider Demographics
NPI:1811999246
Name:SOUTH SHORE REHABILITATION, LLC
Entity type:Organization
Organization Name:SOUTH SHORE REHABILITATION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-697-7523
Mailing Address - Street 1:275 W MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3346
Mailing Address - Country:US
Mailing Address - Phone:516-623-4000
Mailing Address - Fax:516-379-8440
Practice Address - Street 1:275 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3346
Practice Address - Country:US
Practice Address - Phone:516-623-4000
Practice Address - Fax:516-379-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2904300N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2904300NOtherOPERATING CERTIFICATE #
NY003090086Medicaid
NY2904300NOtherOPERATING CERTIFICATE #