Provider Demographics
NPI:1245287168
Name:CAPITAL REGION GERIATRIC CENTER, INC.
Entity type:Organization
Organization Name:CAPITAL REGION GERIATRIC CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-238-4045
Mailing Address - Street 1:421 WEST COLUMBIA STREET
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-2217
Mailing Address - Country:US
Mailing Address - Phone:518-237-5630
Mailing Address - Fax:518-237-0904
Practice Address - Street 1:421 WEST COLUMBIA STREET
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2217
Practice Address - Country:US
Practice Address - Phone:518-237-5630
Practice Address - Fax:518-237-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0102001H282N00000X
NY0102001N282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5613296OtherAETNA
NY10005796OtherCDPHP
NY000400101001OtherBLUE SHIELD OF NE NY
NY002990OtherBLUE CROSS
NY01112234Medicaid
NY102471OtherWELLCARE
NY92078OtherMOHAWK VALLEY PHYSICIANS
NY5613296OtherAETNA
NY33-T407Medicare ID - Type UnspecifiedSUB UNIT PMR