Provider Demographics
NPI:1205158102
Name:HEALTHDIRECT INSTITUTIONAL HEALTH SERVICES
Entity type:Organization
Organization Name:HEALTHDIRECT INSTITUTIONAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WIND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:315-264-0041
Mailing Address - Street 1:515 STEWART DRIVE WEST
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212
Mailing Address - Country:US
Mailing Address - Phone:866-220-7383
Mailing Address - Fax:866-220-7384
Practice Address - Street 1:515 STEWART DR
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-3417
Practice Address - Country:US
Practice Address - Phone:866-220-7383
Practice Address - Fax:866-220-7384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY 039675-1314000000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility