Provider Demographics
NPI:1053308205
Name:SCHENECTADY NURSING AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:SCHENECTADY NURSING AND REHABILITATION CENTER, LLC
Other - Org Name:THE DUTCH MANOR NURSING AND REHABILITATION CENTRE
Other - Org Type:Other Name
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MARTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-346-9640
Mailing Address - Street 1:1940 HAMBURG ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-4791
Mailing Address - Country:US
Mailing Address - Phone:518-370-5051
Mailing Address - Fax:518-374-6271
Practice Address - Street 1:1940 HAMBURG ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-4791
Practice Address - Country:US
Practice Address - Phone:518-370-5051
Practice Address - Fax:518-374-6271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DMN MANAGEMENT SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-03
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4601306N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01239972Medicaid
NY335354Medicare Oscar/Certification