Basic Information
| Provider Information | |||||||||
| NPI: | 1841613163 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SGRNC LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KING DAVID CENTER FOR NURSING AND REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 691 92ND ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112283619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3475602238 | ||||||||
| FaxNumber: | 3472693146 | ||||||||
| Practice Location | |||||||||
| Address1: | 2266 CROPSEY AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182666100 | ||||||||
| FaxNumber: | 3472693146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2014 | ||||||||
| LastUpdateDate: | 05/03/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RUBIN | ||||||||
| AuthorizedOfficialFirstName: | SOLOMON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3475602238 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/03/2022 | ||||||||
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 | 00311257 | 05 | NY | MEDICAID |