Provider Demographics
NPI:1962947390
Name:AZM, LLC
Entity type:Organization
Organization Name:AZM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-324-7393
Mailing Address - Street 1:367 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2815
Mailing Address - Country:US
Mailing Address - Phone:917-324-7393
Mailing Address - Fax:
Practice Address - Street 1:910 S 40TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1827
Practice Address - Country:US
Practice Address - Phone:402-342-2015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
285218Medicare Oscar/Certification