Provider Demographics
NPI:1588650873
Name:LORETTO HEALTH AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:LORETTO HEALTH AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MDS SPECIALIST FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-469-5570
Mailing Address - Street 1:700 E BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2201
Mailing Address - Country:US
Mailing Address - Phone:315-469-5570
Mailing Address - Fax:315-469-0873
Practice Address - Street 1:700 E BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2201
Practice Address - Country:US
Practice Address - Phone:315-469-5570
Practice Address - Fax:315-469-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3301327N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA0189Medicare PIN
NY335136Medicare Oscar/Certification