Organization
SPRAIN BROOK MANOR NURSING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANNE WALLAK (ADMINISTRATOR)
(914) 472-3200
Entity
Organization
Contact information
Practice address
77 JACKSON AVE, SCARSDALE, NY 10583-3140
(914) 472-3200
(914) 472-5443
Mailing address
77 JACKSON AVE, SCARSDALE, NY 10583-3140
(914) 472-3200
(914) 472-5443
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
5910300N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00308338
—
NY
01
—
1114
PFI
NY
01
—
5910300N
OPERATING CERTIFICATE NO.
NY
Enumeration date
07/30/2006
Last updated
08/22/2020
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