Provider Demographics
NPI:1215930292
Name:CGSR, INC
Entity type:Organization
Organization Name:CGSR, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-563-5440
Mailing Address - Street 1:154 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1302
Mailing Address - Country:US
Mailing Address - Phone:518-563-5440
Mailing Address - Fax:518-563-1206
Practice Address - Street 1:154 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1302
Practice Address - Country:US
Practice Address - Phone:518-563-5440
Practice Address - Fax:518-563-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 332BN1400X, 332BP3500X
NY0901303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0140OtherPFI
NY0901303NOtherOPERATING CERTIFICATE NUM
NY02994732Medicaid
NY08-41529-7OtherNYS EMPLOYER ID
NY0901303NOtherOPERATING CERTIFICATE NUM
NY08-41529-7OtherNYS EMPLOYER ID
5316340001Medicare NSC