Provider Demographics
NPI:1710592605
Name:HAMLET AT WALLKILL
Entity Type:Organization
Organization Name:HAMLET AT WALLKILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-305-2230
Mailing Address - Street 1:21 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4048
Mailing Address - Country:US
Mailing Address - Phone:845-695-5600
Mailing Address - Fax:845-695-5601
Practice Address - Street 1:21 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4048
Practice Address - Country:US
Practice Address - Phone:845-695-5600
Practice Address - Fax:845-695-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04197224Medicaid