Provider Demographics
NPI:1952306631
Name:OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.
Other - Org Name:LOURDES AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EGGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MBA
Authorized Official - Phone:607-772-1598
Mailing Address - Street 1:4102 OLD VESTAL RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3531
Mailing Address - Country:US
Mailing Address - Phone:607-772-1598
Mailing Address - Fax:607-771-0669
Practice Address - Street 1:4102 OLD VESTAL RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3531
Practice Address - Country:US
Practice Address - Phone:607-772-1598
Practice Address - Fax:607-771-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0301603251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00337664Medicaid
NY00337664Medicaid