Provider Demographics
NPI:1356491229
Name:HUNTINGTON NURSING HOME INC
Entity Type:Organization
Organization Name:HUNTINGTON NURSING HOME INC
Other - Org Name:HUNTINGTON LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER AND CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-787-4030
Mailing Address - Street 1:196 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1651
Mailing Address - Country:US
Mailing Address - Phone:315-787-4150
Mailing Address - Fax:315-787-4794
Practice Address - Street 1:369 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1654
Practice Address - Country:US
Practice Address - Phone:315-787-4150
Practice Address - Fax:315-787-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01206220Medicaid
NY51069552OtherGHI SECONDARY
NY160743032BOOtherGHI PRIMARY
NYP015003557OtherBLUE CHOICE
NY111210CIOtherPREFERRED CARE GOLD
NY45OtherBLUE CROSS
NY45OtherBLUE CROSS