Basic Information
| Provider Information | |||||||||
| NPI: | 1699494864 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAMBRIDGE BLUE VALLEY SENIOR LIVING LLC | ||||||||
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| OtherOrganizationName: | CAMBRIDGE PLACE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2420 KNAPP ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112351006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189423483 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 N 16TH ST | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665081126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855625321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2022 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | MARGULIES | ||||||||
| AuthorizedOfficialFirstName: | ZISHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7189423483 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.