Provider Demographics
NPI:1306881040
Name:ST CLOUD ROCHELLE PARK LLC
Entity type:Organization
Organization Name:ST CLOUD ROCHELLE PARK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-567-0400
Mailing Address - Street 1:170 53RD ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-4319
Mailing Address - Country:US
Mailing Address - Phone:718-567-0400
Mailing Address - Fax:718-567-0600
Practice Address - Street 1:96 PARKWAY
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4200
Practice Address - Country:US
Practice Address - Phone:201-226-9600
Practice Address - Fax:201-226-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ056301314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
315494Medicare UPIN