1013621473 NPI number — POLSON SNF OPERATIONS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013621473 NPI number — POLSON SNF OPERATIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POLSON SNF OPERATIONS, 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:
POLSON HEALTH & REHABILITATION 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:
1013621473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1777 AVENUE OF THE STATES STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-4779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-366-8300
Provider Business Mailing Address Fax Number:
732-523-5312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 14TH AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POLSON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59860-5321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-883-4378
Provider Business Practice Location Address Fax Number:
732-523-5312
Provider Enumeration Date:
01/10/2023

Additional Information

Authorized Official

Authorized Official Last Name:
YENOWITZ
Authorized Official First Name:
YITZCHOK
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED REPRESENTATIVE
Authorized Official Telephone Number:
323-333-0910

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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