Provider Demographics
NPI:1760576631
Name:CHASE MEMORIAL NURSING HOME CO INC
Entity Type:Organization
Organization Name:CHASE MEMORIAL NURSING HOME CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:60784-770-2100
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:1 TERRACE HEIGHTS
Mailing Address - City:NEW BERLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13411-0250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 TERRACE HTS
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13411-9515
Practice Address - Country:US
Practice Address - Phone:607-847-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474713Medicaid
NY00474713Medicaid
NY1316998131Medicare PIN
NY81105AMedicare PIN
NY00474713Medicaid