Provider Demographics
NPI:1235116286
Name:LUTHERAN SOCIAL SERVICES OF UPSTATE NEW YORK, INC.
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF UPSTATE NEW YORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NURMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-665-8028
Mailing Address - Street 1:715 FALCONER ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-1935
Mailing Address - Country:US
Mailing Address - Phone:716-665-4905
Mailing Address - Fax:716-665-8132
Practice Address - Street 1:715 FALCONER ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-1935
Practice Address - Country:US
Practice Address - Phone:716-665-4905
Practice Address - Fax:716-665-8132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0602308ZN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00314618Medicaid
NY00314618Medicaid