Provider Demographics
NPI:1295727212
Name:ULSTER COUNTY
Entity type:Organization
Organization Name:ULSTER COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:PEREZ
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA RD CDN
Authorized Official - Phone:845-340-3390
Mailing Address - Street 1:99 GOLDEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6442
Mailing Address - Country:US
Mailing Address - Phone:845-340-3390
Mailing Address - Fax:845-340-3871
Practice Address - Street 1:99 GOLDEN HILL DR
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6442
Practice Address - Country:US
Practice Address - Phone:845-340-3390
Practice Address - Fax:845-340-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY55013091 N3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473285Medicaid
335451Medicare ID - Type Unspecified