Provider Demographics
NPI:1699716415
Name:GREAT FALLS OPERATIONS LLC
Entity type:Organization
Organization Name:GREAT FALLS OPERATIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-567-0400
Mailing Address - Street 1:14C 53RD ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2644
Mailing Address - Country:US
Mailing Address - Phone:718-567-0400
Mailing Address - Fax:718-567-0600
Practice Address - Street 1:77 E 43RD ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1116
Practice Address - Country:US
Practice Address - Phone:973-754-6700
Practice Address - Fax:973-754-6707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ706000314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6251404Medicaid
NJ315331Medicare ID - Type Unspecified
NJ6251404Medicaid