Organization
JBG HOLDING COMPANY LLC
Active
Other names
Woodhaven Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH GAUL (ADMINISTRATOR)
(631) 473-7100
Entity
Organization
Contact information
Practice address
1360 ROUTE 112, PORT JEFFERSON STATION, NY 11776-3078
(631) 473-7100
(631) 473-7118
Mailing address
1360 ROUTE 112, PORT JEFFERSON STATION, NY 11776-3078
(631) 473-7100
(631) 473-7118
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
5151316N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00308470
—
NY
01
—
5151316N
NY OPERATING CERTIFICATE
NY
Enumeration date
09/29/2005
Last updated
02/24/2012
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