Provider Demographics
NPI:1083765994
Name:COLER-GOLDWATER SPECIALTY HOSPITAL AND NURSING FACILITY
Entity Type:Organization
Organization Name:COLER-GOLDWATER SPECIALTY HOSPITAL AND NURSING FACILITY
Other - Org Name:HEALTH AND HOSPITALS CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-848-6300
Mailing Address - Street 1:1 MAIN ST
Mailing Address - Street 2:ROOSEVELT ISLAND
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0052
Mailing Address - Country:US
Mailing Address - Phone:212-848-6300
Mailing Address - Fax:212-848-6900
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:ROOSEVELT ISLAND
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-0052
Practice Address - Country:US
Practice Address - Phone:212-848-6300
Practice Address - Fax:212-848-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002337N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY340538Medicaid
NY340547Medicaid
NY7002337NOtherNYS OPERATING CERTIFICATE
NY335092Medicare ID - Type UnspecifiedGOLDWATER CAMPUS MEDICARE
NY340547Medicaid