Provider Demographics
NPI:1962552216
Name:AVALON GARDENS REHABILITATION AND HEALTH CARE CENTER,LLC
Entity type:Organization
Organization Name:AVALON GARDENS REHABILITATION AND HEALTH CARE CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-724-2200
Mailing Address - Street 1:7 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1626
Mailing Address - Country:US
Mailing Address - Phone:631-724-2200
Mailing Address - Fax:631-724-2225
Practice Address - Street 1:7 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1626
Practice Address - Country:US
Practice Address - Phone:631-724-2200
Practice Address - Fax:631-724-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5157313N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01061178Medicaid
NY00315059Medicaid
NY00315059Medicaid