Provider Demographics
NPI:1477754802
Name:KATHERINE LUTHER RESIDENTIAL HEALTHCARE & REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:KATHERINE LUTHER RESIDENTIAL HEALTHCARE & REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-235-7101
Mailing Address - Street 1:110 UTICA RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1548
Mailing Address - Country:US
Mailing Address - Phone:315-853-5515
Mailing Address - Fax:315-853-4025
Practice Address - Street 1:110 UTICA RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1548
Practice Address - Country:US
Practice Address - Phone:315-853-5515
Practice Address - Fax:315-853-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00311413Medicaid
NY335006Medicare Oscar/Certification