Basic Information
| Provider Information | |||||||||
| NPI: | 1215654231 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEDFORD SNF OPCO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2420 KNAPP ST | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112351006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189423483 | ||||||||
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| Practice Location | |||||||||
| Address1: | 480 DONALD ST | ||||||||
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| City: | BEDFORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031105945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036274147 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2022 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | MARGULIES | ||||||||
| AuthorizedOfficialFirstName: | ZISH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7189423483 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.