Basic Information
| Provider Information | |||||||||
| NPI: | 1235187964 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NESCONSET NURSING CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 SOUTHERN BLVD. | ||||||||
| Address2: | |||||||||
| City: | NESCONSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117671797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313618800 | ||||||||
| FaxNumber: | 6313619528 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 SOUTHERN BLVD. | ||||||||
| Address2: | |||||||||
| City: | NESCONSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117671797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313618800 | ||||||||
| FaxNumber: | 6313619528 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 06/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | RANIERI | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6313618800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 00848733 | 05 | NY | MEDICAID | 00848751 | 05 | NY | MEDICAID |