Provider Demographics
NPI:1609820265
Name:THE JAMES A. EDDY MEMORIAL GERIATRIC CENTER, INC.
Entity Type:Organization
Organization Name:THE JAMES A. EDDY MEMORIAL GERIATRIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CBO
Authorized Official - Prefix:MS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-268-4906
Mailing Address - Street 1:55 MOHAWK ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-2600
Mailing Address - Country:US
Mailing Address - Phone:518-274-9890
Mailing Address - Fax:518-274-5407
Practice Address - Street 1:2256 BURDETT AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2400
Practice Address - Country:US
Practice Address - Phone:518-274-9890
Practice Address - Fax:518-274-5407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4102309N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000400135001OtherBLUE SHIELD OF NE NY
NY7740256OtherAETNA
NY00545208Medicaid
NY10030782OtherCDPHP
NY00872899Medicaid
NY009612OtherBLUE CROSS
NY7740256OtherAETNA