Provider Demographics
NPI:1205230711
Name:CCRN OPERATOR LLC
Entity Type:Organization
Organization Name:CCRN OPERATOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUPNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-704-8000
Mailing Address - Street 1:128 PHOENIX MILLS RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-5716
Mailing Address - Country:US
Mailing Address - Phone:607-544-2600
Mailing Address - Fax:
Practice Address - Street 1:128 PHOENIX MILLS RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-5716
Practice Address - Country:US
Practice Address - Phone:607-544-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3824300N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00356414Medicaid
NY335412Medicare Oscar/Certification