Basic Information
| Provider Information | |||||||||
| NPI: | 1225401987 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLOWBROOK SNF MANAGEMENT LLC | ||||||||
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| OtherOrganizationName: | WILLOWBROOK RESIDENCE AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1981 MARCUS AVE | ||||||||
| Address2: | SUITE C129 | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110422060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165965222 | ||||||||
| FaxNumber: | 5167753299 | ||||||||
| Practice Location | |||||||||
| Address1: | 13631 ARDFIELD DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770705837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819559572 | ||||||||
| FaxNumber: | 2819551597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2015 | ||||||||
| LastUpdateDate: | 11/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | DEITSCH | ||||||||
| AuthorizedOfficialFirstName: | ELIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5165965222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.