Basic Information
Provider Information | |||||||||
NPI: | 1518405547 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | GARDEN MANOR REHAB AND NURSING OF SOUTHWEST LLC | ||||||||
LastName: |   | ||||||||
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Mailing Information | |||||||||
Address1: | 99 W HAWTHORNE AVE STE L10 | ||||||||
Address2: |   | ||||||||
City: | VALLEY STREAM | ||||||||
State: | NY | ||||||||
PostalCode: | 115806126 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: |   | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 5600 S WALKER AVE | ||||||||
Address2: |   | ||||||||
City: | OKLAHOMA CITY | ||||||||
State: | OK | ||||||||
PostalCode: | 731098314 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4056327771 | ||||||||
FaxNumber: | 4056322406 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/09/2017 | ||||||||
LastUpdateDate: | 02/09/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
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ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GAMZEH | ||||||||
AuthorizedOfficialFirstName: | DAVID | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
AuthorizedOfficialTelephone: | 9172328045 | ||||||||
IsSoleProprietor: |   | ||||||||
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.