Provider Demographics
NPI:1063570307
Name:LITTLE NECK NURSING HOME
Entity type:Organization
Organization Name:LITTLE NECK NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LANTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-423-6400
Mailing Address - Street 1:26019 NASSAU BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362
Mailing Address - Country:US
Mailing Address - Phone:718-423-6400
Mailing Address - Fax:
Practice Address - Street 1:26019 NASSAU BOULEVARD
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362
Practice Address - Country:US
Practice Address - Phone:718-423-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003337N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00309339Medicaid
NY7003337NOtherOPERATING CERTIFICATE
NY00309339Medicaid