Provider Demographics
NPI:1669658266
Name:SALABER INC.
Entity Type:Organization
Organization Name:SALABER INC.
Other - Org Name:MOUNTAIN VALLEY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPOALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-331-1254
Mailing Address - Street 1:397 WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6223
Mailing Address - Country:US
Mailing Address - Phone:845-331-1254
Mailing Address - Fax:845-331-1255
Practice Address - Street 1:397 WILBUR AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6223
Practice Address - Country:US
Practice Address - Phone:845-331-1254
Practice Address - Fax:845-331-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY740F780310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility