Provider Demographics
NPI:1942507132
Name:BELVEDERE OF ALBANY
Entity Type:Organization
Organization Name:BELVEDERE OF ALBANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCCOOEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-594-9400
Mailing Address - Street 1:3 EAST COMMERCE SQUARE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-2212
Mailing Address - Country:US
Mailing Address - Phone:518-694-9400
Mailing Address - Fax:518-694-0368
Practice Address - Street 1:3 EAST COMMERCE SQUARE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-2212
Practice Address - Country:US
Practice Address - Phone:518-694-9400
Practice Address - Fax:518-694-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353741-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02143057Medicaid