Organization
PINEGROVE MANOR II, LLC
Active
Other names
Grace Plaza Nursing and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY SODANO (ADMINISTRATOR)
(516) 466-3001
Entity
Organization
Contact information
Practice address
15 SAINT PAULS PL, GREAT NECK, NY 11021-2636
(516) 466-3001
(516) 466-7624
Mailing address
15 SAINT PAULS PL, GREAT NECK, NY 11021-2636
(516) 466-3001
(516) 466-7624
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2913301N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00309119
—
NY
01
—
007385
BC/BS
NY
01
—
335483
HIP
NY
01
—
A418337
OXFORD
—
Enumeration date
05/24/2005
Last updated
09/03/2015
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