Provider Demographics
NPI:1801815915
Name:ALBANY COUNTY NURSING HOME
Entity Type:Organization
Organization Name:ALBANY COUNTY NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MORACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-869-2231
Mailing Address - Street 1:780 ALBANY SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1055
Mailing Address - Country:US
Mailing Address - Phone:518-869-2231
Mailing Address - Fax:518-869-1290
Practice Address - Street 1:780 ALBANY SHAKER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211-1055
Practice Address - Country:US
Practice Address - Phone:518-869-2231
Practice Address - Fax:518-869-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0153302N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00309260Medicaid
NY00309260Medicaid