Provider Demographics
NPI:1518021310
Name:CLIFTON SPRINGS SANITARIUM CO
Entity Type:Organization
Organization Name:CLIFTON SPRINGS SANITARIUM CO
Other - Org Name:CLIFTON SPRINGS HOSPITAL AND CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-1223
Mailing Address - Street 1:100 KINGS HIGHWAY SOUTH
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:315-462-9561
Mailing Address - Fax:315-462-3492
Practice Address - Street 1:2 COULTER RD
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1122
Practice Address - Country:US
Practice Address - Phone:315-462-1305
Practice Address - Fax:315-462-3492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3421000H273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354641Medicaid
NY03001801Medicaid
NY03001801Medicaid
NYAA0263Medicare PIN