Provider Demographics
NPI:1487917712
Name:SPRAIN BROOK MANOR REHAB LLC
Entity type:Organization
Organization Name:SPRAIN BROOK MANOR REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NACHFOLGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:845-596-6633
Mailing Address - Street 1:77 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3140
Mailing Address - Country:US
Mailing Address - Phone:914-472-3200
Mailing Address - Fax:
Practice Address - Street 1:77 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3140
Practice Address - Country:US
Practice Address - Phone:914-472-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY308338Medicaid