Provider Demographics
NPI:1225190150
Name:HILLSIDE HEALTH CARE R.N., P.C.
Entity Type:Organization
Organization Name:HILLSIDE HEALTH CARE R.N., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:ARDREY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:845-440-3940
Mailing Address - Street 1:260 OSBORNE HILL RD
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2519
Mailing Address - Country:US
Mailing Address - Phone:845-440-3940
Mailing Address - Fax:
Practice Address - Street 1:260 OSBORNE HILL RD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2519
Practice Address - Country:US
Practice Address - Phone:845-440-3940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY443900-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01457478OtherMEDICAID PROVIDER ID