Organization
SJ3 OP DIVERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL GOLDNER (AUTHORIZED PERSON)
(516) 727-1634
Entity
Organization
Contact information
Practice address
3002 N 18TH ST, SAINT JOSEPH, MO 64505-1872
(516) 364-4200
Mailing address
525 CHESTNUT ST STE 102, CEDARHURST, NY 11516-2223
(516) 727-1634
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
09/14/2022
Last updated
09/14/2022
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