Provider Demographics
NPI:1134580632
Name:HOSPICE AND PALLIATIVE CARE OF ST. LAWRENCE VALLEY, INC
Entity type:Organization
Organization Name:HOSPICE AND PALLIATIVE CARE OF ST. LAWRENCE VALLEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKERING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:315-265-3105
Mailing Address - Street 1:6805 US HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3131
Mailing Address - Country:US
Mailing Address - Phone:315-265-3105
Mailing Address - Fax:315-274-9316
Practice Address - Street 1:6805 US HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3131
Practice Address - Country:US
Practice Address - Phone:315-265-3105
Practice Address - Fax:315-274-9316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083650253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care