Provider Demographics
NPI:1013278746
Name:GUILDERLAND CENTER REHABILITATION & EXTENDED CARE FACILITY OP CO LLC
Entity type:Organization
Organization Name:GUILDERLAND CENTER REHABILITATION & EXTENDED CARE FACILITY OP CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SLEDZIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-382-2427
Mailing Address - Street 1:127 MAIN ST.REET
Mailing Address - Street 2:428 RT. 146
Mailing Address - City:GUILDERLAND CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:12085
Mailing Address - Country:US
Mailing Address - Phone:518-861-5141
Mailing Address - Fax:518-861-5437
Practice Address - Street 1:127 MAIN STREET
Practice Address - Street 2:428 RT. 146
Practice Address - City:GUILDERLAND CENTER
Practice Address - State:NY
Practice Address - Zip Code:12085
Practice Address - Country:US
Practice Address - Phone:518-382-2427
Practice Address - Fax:518-382-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0155303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003111133Medicaid
NY335540Medicare Oscar/Certification