Provider Demographics
NPI:1346618212
Name:CAROLE MARLY SURIN
Entity Type:Organization
Organization Name:CAROLE MARLY SURIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:MARLY
Authorized Official - Last Name:SURIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-300-3886
Mailing Address - Street 1:13 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-4332
Mailing Address - Country:US
Mailing Address - Phone:845-517-2034
Mailing Address - Fax:
Practice Address - Street 1:13 SHERMAN DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-4332
Practice Address - Country:US
Practice Address - Phone:845-300-3886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313619-1311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home