Provider Demographics
NPI:1053391433
Name:JGB HEALTH FACILITIES CORPORATION
Entity type:Organization
Organization Name:JGB HEALTH FACILITIES CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MASTALINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:212-769-6212
Mailing Address - Street 1:15 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6601
Mailing Address - Country:US
Mailing Address - Phone:212-769-6212
Mailing Address - Fax:212-875-9461
Practice Address - Street 1:15 W 65TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6601
Practice Address - Country:US
Practice Address - Phone:212-769-6212
Practice Address - Fax:212-875-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5907313N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00309320Medicaid
NY335512Medicare ID - Type Unspecified