Provider Demographics
NPI:1972683142
Name:ST. JAMES NURSING HOME
Entity Type:Organization
Organization Name:ST. JAMES NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNADETHE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:631-862-8000
Mailing Address - Street 1:275 MORICHES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2150
Mailing Address - Country:US
Mailing Address - Phone:631-862-8000
Mailing Address - Fax:631-862-6456
Practice Address - Street 1:275 MORICHES RD
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2150
Practice Address - Country:US
Practice Address - Phone:631-862-8000
Practice Address - Fax:631-862-6456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5157305N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00311239Medicaid
NY0717450001OtherCLAIM CARE
NY00311239Medicaid