Provider Demographics
NPI:1578550653
Name:TERESIAN HOUSE NURSING HOME CO INC
Entity Type:Organization
Organization Name:TERESIAN HOUSE NURSING HOME CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MDS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:518-456-2000
Mailing Address - Street 1:200 WASHINGTON AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5335
Mailing Address - Country:US
Mailing Address - Phone:518-456-2000
Mailing Address - Fax:
Practice Address - Street 1:200 WASHINGTON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5335
Practice Address - Country:US
Practice Address - Phone:518-456-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00312345Medicaid
NY0101313NMedicaid
NYI55745Medicare PIN
NYF82472Medicare UPIN
NY0101313NMedicaid
NYDD1258Medicare PIN
NYCB1760Medicare PIN
NY1831181981Medicare PIN
NY00312345Medicaid
NY335627Medicare Oscar/Certification
NY80020AMedicare PIN
NYDD5164Medicare PIN
NY1588609895Medicare PIN
NYBB6856Medicare PIN
NY1649248428Medicare PIN
NY55388RMedicare PIN
NY1366434581Medicare PIN
NY1508060880Medicare PIN
NY1962592501Medicare PIN
NYRR12500Medicare PIN