Organization
VICTORY LAKE OPERATIONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD J WOOD CPA (MEMBER)
(845) 229-9177
Entity
Organization
Contact information
Practice address
958 CHURCH ST, BALDWIN, NY 11510-4257
(516) 409-0700
(516) 809-0161
Mailing address
958 CHURCH ST, BALDWIN, NY 11510-4257
(516) 409-0700
(516) 809-0161
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
00308961
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00308961
—
NY
Enumeration date
10/04/2005
Last updated
08/22/2020
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