Provider Demographics
NPI:1336116300
Name:IDEAL SENIOR LIVING CENTER INC
Entity Type:Organization
Organization Name:IDEAL SENIOR LIVING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
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:607-786-7302
Mailing Address - Fax:607-786-7417
Practice Address - Street 1:601 HIGH AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4720
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:2006-03-08
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0302302N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01195995Medicaid
NY335520Medicare ID - Type Unspecified