Provider Demographics
NPI:1942478011
Name:CLIFTON SPRINGS SANITARIUM COMPANY
Entity Type:Organization
Organization Name:CLIFTON SPRINGS SANITARIUM COMPANY
Other - Org Name:CLIFTON SPRINGS HOSPITAL AND CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PFS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-462-0494
Mailing Address - Street 1:4567 CROSSROADS PARK DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3589
Mailing Address - Country:US
Mailing Address - Phone:315-295-2100
Mailing Address - Fax:
Practice Address - Street 1:2 COULTER RD
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1122
Practice Address - Country:US
Practice Address - Phone:315-462-0494
Practice Address - Fax:315-462-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3421000H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0263Medicare PIN