Provider Demographics
NPI:1013902972
Name:GUILDERLAND LTC MANAGEMENT LLC
Entity type:Organization
Organization Name:GUILDERLAND LTC MANAGEMENT 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:PO BOX 9022
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309
Mailing Address - Country:US
Mailing Address - Phone:518-382-2427
Mailing Address - Fax:518-382-2429
Practice Address - Street 1:127 MAIN ST.
Practice Address - Street 2:
Practice Address - City:GUILDERLAND CENTER
Practice Address - State:NY
Practice Address - Zip Code:12085
Practice Address - Country:US
Practice Address - Phone:518-861-5141
Practice Address - Fax:518-861-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0155300N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0031133Medicaid
NY0031133Medicaid