Provider Demographics
NPI:1528003902
Name:GRANVILLE NURSING AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:GRANVILLE NURSING AND REHABILITATION CENTER LLC
Other - Org Name:THE ORCHARD NURSING AND REHABILITATION CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-346-9640
Mailing Address - Street 1:10421 STATE ROUTE 40
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12832-5713
Mailing Address - Country:US
Mailing Address - Phone:518-642-2346
Mailing Address - Fax:518-642-3870
Practice Address - Street 1:10421 STATE ROUTE 40
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-5713
Practice Address - Country:US
Practice Address - Phone:518-642-2346
Practice Address - Fax:518-642-3870
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DMN MANAGEMENT SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5725303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY956381OtherMVP
NY000400690009OtherBLUE SHIELD
NY302056OtherWELLCARE
NY007991OtherEMPIRE BC
NY01167931Medicaid
NY10054923OtherCDPHP
NY956381OtherMVP
NYE569524Medicare UPIN
NY335711Medicare ID - Type Unspecified