Provider Demographics
NPI:1518167329
Name:CARMEL WOLFE HILLCREST SPRING RESIDENTIAL ADULT CARE
Entity Type:Organization
Organization Name:CARMEL WOLFE HILLCREST SPRING RESIDENTIAL ADULT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-843-3770
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-0368
Mailing Address - Country:US
Mailing Address - Phone:518-843-3770
Mailing Address - Fax:518-843-3878
Practice Address - Street 1:5052 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7534
Practice Address - Country:US
Practice Address - Phone:518-843-3770
Practice Address - Fax:518-843-3878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9502L001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01434555Medicaid