Provider Demographics
NPI:1750454567
Name:LUTHERAN CENTER AT POUGHKEEPSIE, INC
Entity Type:Organization
Organization Name:LUTHERAN CENTER AT POUGHKEEPSIE, INC
Other - Org Name:LUTHERAN LONG TERM HOME HEALTH CARE PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP HOME CARE & COMMUNITY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CADOFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:914-365-6365
Mailing Address - Street 1:390 RABRO DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4244
Mailing Address - Country:US
Mailing Address - Phone:631-761-5444
Mailing Address - Fax:631-761-5445
Practice Address - Street 1:390 RABRO DR
Practice Address - Street 2:SUITE B
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4244
Practice Address - Country:US
Practice Address - Phone:631-761-5444
Practice Address - Fax:631-761-5445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5157905L251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00793788Medicaid
NY337201Medicare Oscar/Certification