Provider Demographics
NPI:1790715597
Name:ST. JOSEPH'S HOME
Entity Type:Organization
Organization Name:ST. JOSEPH'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:LNWA05362
Authorized Official - Phone:315-393-3780
Mailing Address - Street 1:950 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4472
Mailing Address - Country:US
Mailing Address - Phone:315-393-3780
Mailing Address - Fax:315-393-3847
Practice Address - Street 1:950 LINDEN ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-4472
Practice Address - Country:US
Practice Address - Phone:315-393-3780
Practice Address - Fax:315-393-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4401300N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY475609Medicaid
335087Medicare ID - Type Unspecified