Basic Information
| Provider Information | |||||||||
| NPI: | 1326492380 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ECRNC LLC | ||||||||
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| OtherOrganizationName: | EVERGREEN COMMONS REHABILITATION AND NURSING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HILLCREST CTR | ||||||||
| Address2: | SUITE #325 | ||||||||
| City: | SPRING VALLEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109773740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453718100 | ||||||||
| FaxNumber: | 8453710010 | ||||||||
| Practice Location | |||||||||
| Address1: | 1070 LUTHER RD | ||||||||
| Address2: | |||||||||
| City: | EAST GREENBUSH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120614020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184794662 | ||||||||
| FaxNumber: | 5184793978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2016 | ||||||||
| LastUpdateDate: | 04/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | STEIF | ||||||||
| AuthorizedOfficialFirstName: | EFRAIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8453718100 | ||||||||
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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.