Basic Information
| Provider Information | |||||||||
| NPI: | 1801827076 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE SILVERCREST CENTER FOR NURSING AND REHABILITATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE SILVERCREST CENTER FOR NURSING AND REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 144-45 87TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114353109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184804000 | ||||||||
| FaxNumber: | 7184804028 | ||||||||
| Practice Location | |||||||||
| Address1: | 144-45 87TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114353109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184804000 | ||||||||
| FaxNumber: | 7184804028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 07/23/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DEFRIN | ||||||||
| AuthorizedOfficialFirstName: | MITCHELL | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT/CHIEF FINANCIAL OFFI | ||||||||
| AuthorizedOfficialTelephone: | 7184804067 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | 7003372N | NY | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 314000000X | 7003372N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 01215512 | 05 | NY | MEDICAID |