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Organization

SELF

Active
Parent organization
SELF
Organization subpart
Yes

Provider details

NPI number
Legal business name
SELF
Authorized official
ELCIE BESSE (LPN)
(631) 413-6210
Entity
Organization

Contact information

Practice address
4 SPRUCE RD, AMITYVILLE, NY 11701-1019
(631) 413-6210
Mailing address
4 SPRUCE RD, AMITYVILLE, NY 11701-1019

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
102980029
NY

Other

Enumeration date
06/02/2013
Last updated
06/02/2013
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