33D2126456 CLIA NUMBER - PROVIDENCE CARE INC DBA BROOKLYN GARDENS NURSING AND REHABILITATION CENTER

Laboratory Demographics

  • CLIA Code: 33D2126456
  • Facility Name: PROVIDENCE CARE INC DBA BROOKLYN GARDENS NURSING AND REHABILITATION CENTER
  • Facility Address: 835 HERKIMER STREET
    BROOKLYN, NY
    ZIP 11233
  • Facility Phone: 718 221-2600
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DR. MARK ILYAGU
  • NPI Number: 1467869602
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 33D2126456
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PROVIDENCE CARE INC DBA BROOKLYN GARDENS NURSING AND REHABILITATION CENTER
Street 835 HERKIMER STREET
City BROOKLYN
State NY
ZIP 11233
Phone 718 221-2600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/28/2017
Certificate Expiration Date 3/26/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director DR. MARK ILYAGU

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This page was last updated on: 9/29/2025