Provider Demographics
NPI:1376525378
Name:CROUSE-COMMUNITY CENTER, INC
Entity Type:Organization
Organization Name:CROUSE-COMMUNITY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HIGHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-684-5117
Mailing Address - Street 1:101 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13408-2106
Mailing Address - Country:US
Mailing Address - Phone:315-684-9595
Mailing Address - Fax:315-684-9275
Practice Address - Street 1:101 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NY
Practice Address - Zip Code:13408-2106
Practice Address - Country:US
Practice Address - Phone:315-684-9595
Practice Address - Fax:315-684-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
NY2623300N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474337Medicaid
NY01927999Medicaid
NY00474337Medicaid
NY01927999Medicaid