Provider Demographics
NPI:1750477923
Name:BROOME COUNTY
Entity Type:Organization
Organization Name:BROOME COUNTY
Other - Org Name:WILLOW POINT NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-763-4201
Mailing Address - Street 1:3700 VESTAL RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2229
Mailing Address - Country:US
Mailing Address - Phone:607-763-4400
Mailing Address - Fax:607-763-4442
Practice Address - Street 1:3700 VESTAL RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2229
Practice Address - Country:US
Practice Address - Phone:607-763-4400
Practice Address - Fax:607-763-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00308916Medicaid
NY00308916Medicaid