Provider Demographics
NPI:1356496053
Name:STANTON REHAB CENTRE
Entity Type:Organization
Organization Name:STANTON REHAB CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHARGE NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:518-338-1336
Mailing Address - Street 1:420 LUZERNE ROAD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804
Mailing Address - Country:US
Mailing Address - Phone:518-338-1336
Mailing Address - Fax:
Practice Address - Street 1:152 SHERMAN AVENUE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-793-2575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility