Provider Demographics
NPI:1184007809
Name:ALICE HYDE MEDICAL CENTER
Entity Type:Organization
Organization Name:ALICE HYDE MEDICAL CENTER
Other - Org Name:THE ALICE CENTER HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALP ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUROFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-481-8401
Mailing Address - Street 1:45 SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953
Mailing Address - Country:US
Mailing Address - Phone:518-481-8401
Mailing Address - Fax:518-481-8403
Practice Address - Street 1:45 SIXTH ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953
Practice Address - Country:US
Practice Address - Phone:518-481-8401
Practice Address - Fax:518-481-8403
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALICE HYDE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-30
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2461L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health