Provider Demographics
NPI:1639166341
Name:SCHENECTADY NURSING AND REHABILITATION CENTER,LLC
Entity Type:Organization
Organization Name:SCHENECTADY NURSING AND REHABILITATION CENTER,LLC
Other - Org Name:THE CAPITAL LIVING NURSING & REHABILITATION CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:518-346-6121
Mailing Address - Street 1:526 ALTAMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-1039
Mailing Address - Country:US
Mailing Address - Phone:518-346-6121
Mailing Address - Fax:518-346-7512
Practice Address - Street 1:526 ALTAMONT AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-1039
Practice Address - Country:US
Practice Address - Phone:518-346-6121
Practice Address - Fax:518-346-7512
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DMN MANAGEMENT SERVICES , LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-29
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4601306N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00313617Medicaid
NY335014Medicare ID - Type Unspecified