Basic Information
| Provider Information | |||||||||
| NPI: | 1053460071 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KING DAVID CENTER FOR NURSING AND REHABILITATION ADHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2266 CROPSEY AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112145706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182666100 | ||||||||
| FaxNumber: | 7183632875 | ||||||||
| Practice Location | |||||||||
| Address1: | 2266 CROPSEY AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112145706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182666100 | ||||||||
| FaxNumber: | 7183632875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 07/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | JAROSLAWICZ | ||||||||
| AuthorizedOfficialFirstName: | CONNIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7185671000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
ID Information
| ID | Type | State | Issuer | Description | 02104772 | 05 | NH | MEDICAID |