Provider Demographics
NPI:1083778385
Name:HUDSON RIVER HEALTHCARE, INC.
Entity Type:Organization
Organization Name:HUDSON RIVER HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:NOLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-734-8747
Mailing Address - Street 1:1200 BROWN ST
Mailing Address - Street 2:4TH FLOOR - CREDENTIALING
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-3617
Mailing Address - Country:US
Mailing Address - Phone:914-734-8600
Mailing Address - Fax:914-734-8745
Practice Address - Street 1:11 PILCH STREET
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:PINE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12567
Practice Address - Country:US
Practice Address - Phone:845-398-1100
Practice Address - Fax:845-398-7108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUDSON RIVER HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473038Medicaid
NY331901Medicare Oscar/Certification