Provider Demographics
NPI:1417087305
Name:MERCY OF NORTHERN NEW YORK
Entity Type:Organization
Organization Name:MERCY OF NORTHERN NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-782-7400
Mailing Address - Street 1:218 STONE ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3211
Mailing Address - Country:US
Mailing Address - Phone:315-782-7400
Mailing Address - Fax:
Practice Address - Street 1:218 STONE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3211
Practice Address - Country:US
Practice Address - Phone:315-782-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01226071Medicaid
NY2201001NOtherOPERATING CERTIFICATE #
NY335001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER