Provider Demographics
NPI:1245405489
Name:IDEAL SENIOR LIVING CENTER HOUSING CORP
Entity Type:Organization
Organization Name:IDEAL SENIOR LIVING CENTER HOUSING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-786-7307
Mailing Address - Street 1:508 HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-4719
Mailing Address - Country:US
Mailing Address - Phone:607-786-7307
Mailing Address - Fax:607-786-7417
Practice Address - Street 1:600 HIGH AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4789
Practice Address - Country:US
Practice Address - Phone:607-786-7300
Practice Address - Fax:607-786-7417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030E039310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01945399Medicaid