Provider Demographics
NPI:1649370990
Name:PRESBYTERIAN HOME FOR CENTRAL NEW YORK INC
Entity type:Organization
Organization Name:PRESBYTERIAN HOME FOR CENTRAL NEW YORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-272-2201
Mailing Address - Street 1:PO BOX 1144
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-0710
Mailing Address - Country:US
Mailing Address - Phone:315-797-7500
Mailing Address - Fax:315-797-4547
Practice Address - Street 1:4290 MIDDLE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5314
Practice Address - Country:US
Practice Address - Phone:315-797-7500
Practice Address - Fax:315-797-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3227303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00316789Medicaid
NY00316789Medicaid