Provider Demographics
NPI:1558365312
Name:918 JAMES RECEIVER, LLC
Entity Type:Organization
Organization Name:918 JAMES RECEIVER, LLC
Other - Org Name:JAMES SQUARE NURSING HOME, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SR. VICE PRESIDENT, FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-474-1561
Mailing Address - Street 1:918 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2500
Mailing Address - Country:US
Mailing Address - Phone:315-474-1561
Mailing Address - Fax:315-477-1417
Practice Address - Street 1:918 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2500
Practice Address - Country:US
Practice Address - Phone:315-474-1561
Practice Address - Fax:315-477-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3301322N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00356390Medicaid
NY00356390Medicaid
NY33-5338Medicare Oscar/Certification