Basic Information
| Provider Information | |||||||||
| NPI: | 1912614231 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRING CREEK REHAB LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 VIRGINIA AVE | ||||||||
| Address2: | |||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070121222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176134386 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 S 16TH ST | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420712804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707522900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2022 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | WEISS | ||||||||
| AuthorizedOfficialFirstName: | NAFTALI | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED SIGNATORY | ||||||||
| AuthorizedOfficialTelephone: | 9176134386 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.