Basic Information
| Provider Information | |||||||||
| NPI: | 1114580248 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHITES CREEK OPERATING GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 544 PARK AVE STE B04 | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112051670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176823129 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3425 KNIGHT DR | ||||||||
| Address2: | |||||||||
| City: | WHITES CREEK | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371899189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158762754 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2019 | ||||||||
| LastUpdateDate: | 04/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | NIEDERMAN | ||||||||
| AuthorizedOfficialFirstName: | ANSHEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6299002005 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.