Provider Demographics
NPI:1942246491
Name:SCHENECTADY CNTY GLENDL NURSING FAC
Entity Type:Organization
Organization Name:SCHENECTADY CNTY GLENDL NURSING FAC
Other - Org Name:SCHENECTADY COUNTY GLENDALE NURSING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-384-3635
Mailing Address - Street 1:59 HETCHELTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-5506
Mailing Address - Country:US
Mailing Address - Phone:518-384-3635
Mailing Address - Fax:518-399-5732
Practice Address - Street 1:59 HETCHELTOWN RD
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-5506
Practice Address - Country:US
Practice Address - Phone:518-384-3635
Practice Address - Fax:518-399-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NYNY0168133336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473863Medicaid
2060818OtherPK