Provider Demographics
NPI:1396742482
Name:SYRACUSE HOME ASSOCIATION
Entity type:Organization
Organization Name:SYRACUSE HOME ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-638-2521
Mailing Address - Street 1:7740 MEIGS RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9757
Mailing Address - Country:US
Mailing Address - Phone:315-638-2521
Mailing Address - Fax:315-638-2552
Practice Address - Street 1:7740 MEIGS RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9757
Practice Address - Country:US
Practice Address - Phone:315-638-2521
Practice Address - Fax:315-638-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3327301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00436737Medicaid
NY00436737Medicaid