1679573109 NPI number — SAN SIMEON BY THE SOUND CENTER FOR NURSING AND REHABILITATION, INC.

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 1679573109 NPI number — SAN SIMEON BY THE SOUND CENTER FOR NURSING AND REHABILITATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN SIMEON BY THE SOUND CENTER FOR NURSING AND REHABILITATION, INC.
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:
Provider Other Organization Name Type Code:
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:
1679573109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61700 ROUTE 48
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11944-2206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-477-2110
Provider Business Mailing Address Fax Number:
631-477-3987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61700 ROUTE 48
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11944-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-477-2110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SMYTH
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
631-477-2110

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  5127300N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00396589 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com