Provider Demographics
NPI:1417931619
Name:THE NOTTINGHAM RESIDENTIAL HEALTH CARE FACILITY
Entity Type:Organization
Organization Name:THE NOTTINGHAM RESIDENTIAL HEALTH CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-413-3688
Mailing Address - Street 1:1305 NOTTINGHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-8790
Mailing Address - Country:US
Mailing Address - Phone:315-446-0123
Mailing Address - Fax:315-498-9073
Practice Address - Street 1:1305 NOTTINGHAM RD
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-8790
Practice Address - Country:US
Practice Address - Phone:315-446-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3353301N314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
81138AMedicare PIN
NY335800Medicare Oscar/Certification