Provider Demographics
NPI:1538104989
Name:MINOA NURSING AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:MINOA NURSING AND REHABILITATION CENTER LLC
Other - Org Name:THE CROSSINGS 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 1:217 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:MINOA
Mailing Address - State:NY
Mailing Address - Zip Code:13116-1205
Mailing Address - Country:US
Mailing Address - Phone:315-656-7277
Mailing Address - Fax:315-656-2517
Practice Address - Street 1:217 EAST AVE
Practice Address - Street 2:
Practice Address - City:MINOA
Practice Address - State:NY
Practice Address - Zip Code:13116-1205
Practice Address - Country:US
Practice Address - Phone:315-656-7277
Practice Address - Fax:315-656-2517
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DMN MANAGEMENT SERVICES , LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-19
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3334303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00774465Medicaid
NY956381OtherMVP
NY007991OtherEMPIRE BC
NY335548Medicare ID - Type Unspecified
NY00774465Medicaid