Provider Demographics
NPI:1578663845
Name:ELCOR HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ELCOR HEALTH SERVICES, INC.
Other - Org Name:ELCOR NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:POES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-739-0304
Mailing Address - Street 1:48 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8532
Mailing Address - Country:US
Mailing Address - Phone:607-739-0304
Mailing Address - Fax:607-796-0540
Practice Address - Street 1:48 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8532
Practice Address - Country:US
Practice Address - Phone:607-739-0304
Practice Address - Fax:607-796-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0722303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00365866Medicaid
NY02996330Medicaid
NY00357988Medicaid
NY00357988Medicaid