Provider Demographics
NPI:1588658215
Name:FOUNDERS PAVILION, INC.
Entity Type:Organization
Organization Name:FOUNDERS PAVILION, INC.
Other - Org Name:GF CORNING, INC - FOUNDERS PAVILION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:607-654-2410
Mailing Address - Street 1:205 E. 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830
Mailing Address - Country:US
Mailing Address - Phone:607-654-2400
Mailing Address - Fax:607-654-2403
Practice Address - Street 1:205 E. 1ST STREET
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830
Practice Address - Country:US
Practice Address - Phone:607-654-2400
Practice Address - Fax:607-654-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5001001N314000000X
NY03A2247314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00352185Medicaid
NY01811994Medicaid
335330Medicare PIN
NY01811994Medicaid