Provider Demographics
NPI:1124015664
Name:AUBURN AGT,LLC
Entity type:Organization
Organization Name:AUBURN AGT,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-253-7351
Mailing Address - Street 1:85 THORNTON AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4654
Mailing Address - Country:US
Mailing Address - Phone:315-253-7351
Mailing Address - Fax:315-253-0300
Practice Address - Street 1:85 THORNTON AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4654
Practice Address - Country:US
Practice Address - Phone:315-253-7351
Practice Address - Fax:315-253-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00356212Medicaid
NY00356212Medicaid