Provider Demographics
NPI: | 1366683344 |
---|---|
Name: | ST. MARY'S HEALTHCARE |
Entity Type: | Organization |
Organization Name: | ST. MARY'S HEALTHCARE |
Other - Org Name: | WILKINSON RESIDENTIAL HEALTH CARE FACILITY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT/CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | VICTOR |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GIULIANELLI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 518-841-7101 |
Mailing Address - Street 1: | 427 GUY PARK AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | AMSTERDAM |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12010-1054 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 518-841-7434 |
Mailing Address - Fax: | 518-841-7433 |
Practice Address - Street 1: | 4988 STATE HIGHWAY 30 |
Practice Address - Street 2: | |
Practice Address - City: | AMSTERDAM |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12010-7520 |
Practice Address - Country: | US |
Practice Address - Phone: | 518-841-3572 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ST. MARY'S HOSPITAL |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2009-03-20 |
Last Update Date: | 2011-06-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |