Provider Demographics
NPI:1124013115
Name:PLAZA NURSING HOME COMPANY INC.
Entity Type:Organization
Organization Name:PLAZA NURSING HOME COMPANY INC.
Other - Org Name:ROSEWOOD HEIGHTS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:WARRINER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:315-474-4431
Mailing Address - Street 1:614 S CROUSE AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1711
Mailing Address - Country:US
Mailing Address - Phone:315-474-4431
Mailing Address - Fax:315-474-7177
Practice Address - Street 1:614 S CROUSE AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1711
Practice Address - Country:US
Practice Address - Phone:315-474-4431
Practice Address - Fax:315-474-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3301323N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00356405Medicaid