Provider Demographics
NPI:1871820076
Name:CAYUGA RIDGE, LLC
Entity Type:Organization
Organization Name:CAYUGA RIDGE, LLC
Other - Org Name:CAYUGA RIDGE EXTENDED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-273-0373
Mailing Address - Street 1:1229 TRUMANSBURG ROAD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1313
Mailing Address - Country:US
Mailing Address - Phone:607-273-8072
Mailing Address - Fax:607-273-0373
Practice Address - Street 1:1229 TRUMANSBURG ROAD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1313
Practice Address - Country:US
Practice Address - Phone:607-273-8072
Practice Address - Fax:607-273-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5401311N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00308181Medicaid
NY00308181Medicaid
NY335249Medicare Oscar/Certification