Provider Demographics
NPI:1982244935
Name:SOUTH COUNTY SNF OPERATIONS LLC
Entity Type:Organization
Organization Name:SOUTH COUNTY SNF OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SHIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:IDELS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:917-565-7391
Mailing Address - Street 1:1195 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2316
Mailing Address - Country:US
Mailing Address - Phone:646-275-4510
Mailing Address - Fax:
Practice Address - Street 1:740 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-7205
Practice Address - Country:US
Practice Address - Phone:646-275-4510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility