Provider Demographics
NPI:1477505428
Name:COUNTY OF WASHINGTON NEW YORK
Entity Type:Organization
Organization Name:COUNTY OF WASHINGTON NEW YORK
Other - Org Name:PLEASANT VALLEY ADULT HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-638-8274
Mailing Address - Street 1:4573 STATE ROUTE 40
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:NY
Mailing Address - Zip Code:12809-3474
Mailing Address - Country:US
Mailing Address - Phone:518-638-8274
Mailing Address - Fax:518-638-6594
Practice Address - Street 1:4573 STATE ROUTE 40
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:NY
Practice Address - Zip Code:12809-3474
Practice Address - Country:US
Practice Address - Phone:518-638-8274
Practice Address - Fax:518-638-6594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY760-N-001311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY335413Medicare Oscar/Certification
81012AMedicare UPIN