Provider Demographics
NPI:1124410790
Name:HOMELIFE AT FOLTS LLC
Entity Type:Organization
Organization Name:HOMELIFE AT FOLTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:RANKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-369-1297
Mailing Address - Street 1:104 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-2028
Mailing Address - Country:US
Mailing Address - Phone:315-866-6964
Mailing Address - Fax:
Practice Address - Street 1:104 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-2028
Practice Address - Country:US
Practice Address - Phone:315-866-6964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311ZA0620X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY335510Medicare Oscar/Certification