Provider Demographics
NPI:1568550325
Name:ST LUKE'S HOME RESIDENTIAL HEALTHCARE FACILITY INC
Entity Type:Organization
Organization Name:ST LUKE'S HOME RESIDENTIAL HEALTHCARE FACILITY INC
Other - Org Name:MVHS REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-801-4429
Mailing Address - Street 1:2209 GENESEE ST/ BUSINESS OFFICE
Mailing Address - Street 2:ROOM #315
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5809
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:
Practice Address - Street 1:1650 CHAMPLIN AVE.
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502
Practice Address - Country:US
Practice Address - Phone:315-624-8600
Practice Address - Fax:315-624-5152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKE'S RESIDENTIAL HEALTHCARE FACILITY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02779720Medicaid