Provider Demographics
NPI:1174510531
Name:CAMPBELL HALL REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:CAMPBELL HALL REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:516-409-0700
Mailing Address - Street 1:23 KIERNAN RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2200
Mailing Address - Country:US
Mailing Address - Phone:845-294-8154
Mailing Address - Fax:845-294-9651
Practice Address - Street 1:23 KIERNAN RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL HALL
Practice Address - State:NY
Practice Address - Zip Code:10916-2200
Practice Address - Country:US
Practice Address - Phone:845-294-8154
Practice Address - Fax:845-294-9651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00734294314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00734294Medicaid
NY=========OtherFEDERAL ID #
NY=========OtherFEDERAL ID #