Provider Demographics
NPI:1013026863
Name:PALISADE NURSING HOME CO INC.
Entity Type:Organization
Organization Name:PALISADE NURSING HOME CO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-581-1313
Mailing Address - Street 1:5901 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1205
Mailing Address - Country:US
Mailing Address - Phone:718-581-1310
Mailing Address - Fax:718-796-7534
Practice Address - Street 1:5901 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1205
Practice Address - Country:US
Practice Address - Phone:718-581-1310
Practice Address - Fax:718-796-7534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000347N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00309164Medicaid
NY33-5629OtherMEDICARE PROVIDER NUMBER