Provider Demographics
NPI:1326213455
Name:NORTHBROOK HEIGHTS ALP
Entity Type:Organization
Organization Name:NORTHBROOK HEIGHTS ALP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-253-2755
Mailing Address - Street 1:170 MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1335
Mailing Address - Country:US
Mailing Address - Phone:315-253-2755
Mailing Address - Fax:
Practice Address - Street 1:170 MURRAY ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1335
Practice Address - Country:US
Practice Address - Phone:315-253-2755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02044888Medicaid
NY02132525Medicaid