Provider Demographics
NPI:1467471375
Name:HYDE PARK NURSING HOME, INC.
Entity Type:Organization
Organization Name:HYDE PARK NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YENOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-889-4500
Mailing Address - Street 1:4975 ALBANY POST ROAD
Mailing Address - Street 2:
Mailing Address - City:STAATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12580
Mailing Address - Country:US
Mailing Address - Phone:845-889-4500
Mailing Address - Fax:845-889-4309
Practice Address - Street 1:4975 ALBANY POST ROAD
Practice Address - Street 2:
Practice Address - City:STAATSBURG
Practice Address - State:NY
Practice Address - Zip Code:12580
Practice Address - Country:US
Practice Address - Phone:845-889-4500
Practice Address - Fax:845-889-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1356302N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310283Medicaid
NY335404Medicare ID - Type Unspecified