Provider Demographics
NPI:1285815308
Name:GERTRUDE NELSON
Entity Type:Organization
Organization Name:GERTRUDE NELSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GERTRUDE
Authorized Official - Middle Name:DELORES
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSW, MPH
Authorized Official - Phone:845-426-2601
Mailing Address - Street 1:8 PAULINE CT
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6529
Mailing Address - Country:US
Mailing Address - Phone:845-426-2601
Mailing Address - Fax:
Practice Address - Street 1:8 PAULINE CT
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-6529
Practice Address - Country:US
Practice Address - Phone:845-426-2601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352891-13140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric