Provider Demographics
NPI:1336134287
Name:STAMFORD HEALTH CARE SOCIETY, INC.
Entity Type:Organization
Organization Name:STAMFORD HEALTH CARE SOCIETY, INC.
Other - Org Name:ROBINSON TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-652-7521
Mailing Address - Street 1:28652 STATE HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12167-1712
Mailing Address - Country:US
Mailing Address - Phone:607-652-7521
Mailing Address - Fax:607-652-3362
Practice Address - Street 1:28652 STATE HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:NY
Practice Address - Zip Code:12167-1712
Practice Address - Country:US
Practice Address - Phone:607-652-7521
Practice Address - Fax:607-652-3362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1225000N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00391731Medicaid
NY335236Medicare ID - Type UnspecifiedPROVIDER NUMBER
NY00391731Medicaid