Organization
PARK NURSING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PATRICK RUSSELL (ADMINISTRATOR)
(718) 474-6400
Entity
Organization
Contact information
Practice address
128 BEACH 115 STREET, ROCKAWAY PARK, NY 11694
(718) 474-6400
(718) 474-9669
Mailing address
128 BEACH 115 STREET, ROCKAWAY PARK, NY 11694
(718) 474-6400
(718) 474-9669
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00312487
—
NY
Enumeration date
10/31/2005
Last updated
03/12/2008
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