1730142803 NPI number — GREEN VALLEY TERRACE SNF LLC

Table of content: (NPI 1730142803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730142803 NPI number — GREEN VALLEY TERRACE SNF LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREEN VALLEY TERRACE SNF LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ATLANTIC SHORE REHAB & HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730142803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 RELLA BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEBELLO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10901-4239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-551-4803
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLSBORO
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19966-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-934-7300
Provider Business Practice Location Address Fax Number:
302-934-9399
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHOSHANA
Authorized Official First Name:
FAIGE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CONTRACTING
Authorized Official Telephone Number:
732-551-4803

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1100 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0001088211 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001088312 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155A21 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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