Provider Demographics
NPI:1073507729
Name:MERCY HEALTH & REHABILITATION CENTER NURSING HOME COMPANY INC
Entity Type:Organization
Organization Name:MERCY HEALTH & REHABILITATION CENTER NURSING HOME COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-253-0351
Mailing Address - Street 1:3 SAINT ANTHONY ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4525
Mailing Address - Country:US
Mailing Address - Phone:315-253-0351
Mailing Address - Fax:315-258-8010
Practice Address - Street 1:3 SAINT ANTHONY ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4525
Practice Address - Country:US
Practice Address - Phone:315-253-0351
Practice Address - Fax:315-258-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0501308N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0501308NMedicaid
NY0501308NMedicaid
NY335382Medicare ID - Type UnspecifiedPROVIDER NUMBER