Provider Demographics
NPI:1114095171
Name:SETON HEALTH AT SCHUYLER RIDGE RESIDENTIAL HEALTHCARE
Entity Type:Organization
Organization Name:SETON HEALTH AT SCHUYLER RIDGE RESIDENTIAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-275-4258
Mailing Address - Street 1:1 ABELE DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2951
Mailing Address - Country:US
Mailing Address - Phone:518-371-1400
Mailing Address - Fax:518-371-1240
Practice Address - Street 1:1 ABELE DR
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2951
Practice Address - Country:US
Practice Address - Phone:518-371-1400
Practice Address - Fax:518-371-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4552300N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02994094Medicaid
33-5774OtherMEDICARE A PROVIDER NUMBER
NY01470539Medicaid
J100000128OtherMEDICARE B