Provider Demographics
NPI:1710264080
Name:PHYLLIS CALLENDER
Entity Type:Organization
Organization Name:PHYLLIS CALLENDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:347-721-6190
Mailing Address - Street 1:14 KNOLLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-1138
Mailing Address - Country:US
Mailing Address - Phone:347-721-6190
Mailing Address - Fax:
Practice Address - Street 1:14 KNOLLVIEW DR
Practice Address - Street 2:
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564-1138
Practice Address - Country:US
Practice Address - Phone:347-721-6190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289539-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility