Provider Demographics
NPI:1972663508
Name:CENTER FOR DISABILITY SERVICE HOLDING CORPORATION
Entity Type:Organization
Organization Name:CENTER FOR DISABILITY SERVICE HOLDING CORPORATION
Other - Org Name:ST MARGARET'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GREGROY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SORRENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:CFO/TREASURER
Authorized Official - Phone:518-944-2104
Mailing Address - Street 1:314 S MANNING BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1708
Mailing Address - Country:US
Mailing Address - Phone:518-437-5574
Mailing Address - Fax:518-437-5705
Practice Address - Street 1:27 HACKETT BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3420
Practice Address - Country:US
Practice Address - Phone:518-591-3323
Practice Address - Fax:518-591-3320
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR DISABILITY SVC HOLDING CORPORATI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-12
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00312441314000000X, 3140N1450X
NY0101307N314000000X, 3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0101307NOtherLICENSE/OPER CERT
NY00312441Medicaid