Provider Demographics
NPI:1871241380
Name:NORTH LAKE NURSING AND REHAB LLC
Entity type:Organization
Organization Name:NORTH LAKE NURSING AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-490-6060
Mailing Address - Street 1:750 BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-3248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 BAYBERRY DR
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-3248
Practice Address - Country:US
Practice Address - Phone:561-881-8144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility