Provider Demographics
NPI:1265652838
Name:FIREMEN'S HOME OF THE STATE OF NEW YORK
Entity Type:Organization
Organization Name:FIREMEN'S HOME OF THE STATE OF NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:E
Authorized Official - Last Name:WITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:518-828-7695
Mailing Address - Street 1:125 HARRY HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1601
Mailing Address - Country:US
Mailing Address - Phone:518-828-7695
Mailing Address - Fax:518-828-1092
Practice Address - Street 1:125 HARRY HOWARD AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1601
Practice Address - Country:US
Practice Address - Phone:518-828-7695
Practice Address - Fax:518-828-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1001303N3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1001303NOtherOPERATING CERTIFICATE