South Shore Manor Home for Adults

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

SOUTH SHORE MANOR HOME FOR ADULTS

Practice address

1041 E 83Rd St
Brooklyn, NY 11236-4225

Phone

(718) 241-7035

NPI assigned

Nov 10, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jennifer Grajales

Title

Director of Special Projects

Phone

(347) 988-4535

Specialties & licenses 1

Addresses

Other names 1

• New South Shore Manor Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668038400000",
    "number": "1457069270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2357 60TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112042689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 E 83RD ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112364225",
            "telephone_number": "718-241-7035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE MANOR HOME FOR ADULTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-10",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A",
        "authorized_official_last_name": "GRAJALES",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "DIRECTOR OF SPECIAL PROJECTS",
        "authorized_official_telephone_number": "347-988-4535",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New South Shore Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South Brooklyn Nephrology Center Inc
• South Brooklyn Pharma Corp
• South Brooklyn Psychological Services PLLC
• South Brooklyn Radiology PLLC
• South Elliot South Portland Medical Comprehensive Medical Center
• South Shore Osteopathic Medicine P.C.
• South Side Drugs Inc
• South Side Pharmacy & Health Shop LLC
• South Side Pharmacy & Health Shop LLC
• Suzan South-Hylton, LPN

• Adult Care Home Facility in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Adult Care Home Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.