Provider Demographics
NPI:1376537019
Name:JEWISH HOME OF CENTRAL NEW YORK INC.
Entity Type:Organization
Organization Name:JEWISH HOME OF CENTRAL NEW YORK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-446-9111
Mailing Address - Street 1:4101 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2136
Mailing Address - Country:US
Mailing Address - Phone:315-446-9111
Mailing Address - Fax:315-449-0497
Practice Address - Street 1:4101 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-2136
Practice Address - Country:US
Practice Address - Phone:315-446-9111
Practice Address - Fax:315-449-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335190314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY335190Medicare Oscar/Certification