Provider Demographics
NPI:1063629764
Name:STATE OF NEW YORK COMPTROLLERS OFFICE
Entity Type:Organization
Organization Name:STATE OF NEW YORK COMPTROLLERS OFFICE
Other - Org Name:NYS VETERANS HOME AT BATAVIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-474-2772
Mailing Address - Street 1:220 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1227
Mailing Address - Country:US
Mailing Address - Phone:585-345-2076
Mailing Address - Fax:585-345-9030
Practice Address - Street 1:220 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1227
Practice Address - Country:US
Practice Address - Phone:585-345-2076
Practice Address - Fax:585-345-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1801305N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01607230Medicaid
NY12041AOtherMEDICARE PTAN
NY335788Medicare Oscar/Certification
NY12041AOtherMEDICARE PTAN