Provider Demographics
NPI:1700952876
Name:ST. JAMES PLAZA NURSING FACILITY, LLC
Entity Type:Organization
Organization Name:ST. JAMES PLAZA NURSING FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAFFA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NHA
Authorized Official - Phone:631-862-8990
Mailing Address - Street 1:273 MORICHES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2117
Mailing Address - Country:US
Mailing Address - Phone:631-862-8990
Mailing Address - Fax:631-862-6792
Practice Address - Street 1:273 MORICHES RD
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2117
Practice Address - Country:US
Practice Address - Phone:631-862-8990
Practice Address - Fax:631-862-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5157308N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009536OtherEMPIRE BLUE CROSS
NY522087699OtherCOMMONWEALTH INDEMNITY
NY00312029Medicaid
NY335739Medicare ID - Type UnspecifiedPROVIDER NUMBER