Organization
OUR LADY OF CONSOLATION GERIATRIC CARE CENTER
Active
Other names
Our Lady of Consolation Nursing & Rehabilitative Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH O'DOHERTY (COO & SVP FINANCE)
(631) 465-6568
Entity
Organization
Contact information
Practice address
111 BEACH DR, WEST ISLIP, NY 11795-4929
(631) 587-1600
(631) 587-3263
Mailing address
111 BEACH DR, WEST ISLIP, NY 11795-4929
(631) 587-1600
(631) 587-3263
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
5154319N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00311440
—
NY
01
—
007932
BLUE CROSS PROVIDER #
NY
01
—
62124
VYTRA PROVIDER #
NY
01
—
A940385
OXFORD PROVIDER #
NY
Enumeration date
09/22/2005
Last updated
07/29/2025
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