Provider Demographics
NPI:1780130591
Name:WILLCARE
Entity type:Organization
Organization Name:WILLCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:V
Authorized Official - Last Name:RANIERI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:518-755-2812
Mailing Address - Street 1:803 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE KATRINE
Mailing Address - State:NY
Mailing Address - Zip Code:12449-5352
Mailing Address - Country:US
Mailing Address - Phone:845-331-5064
Mailing Address - Fax:
Practice Address - Street 1:803 GRANT ANENUE
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449
Practice Address - Country:US
Practice Address - Phone:845-331-5064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY457210-1311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home