Provider Demographics
NPI:1801889746
Name:MOSES LUDINGTON NURSING HOME COMPANY, INC
Entity type:Organization
Organization Name:MOSES LUDINGTON NURSING HOME COMPANY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-585-3800
Mailing Address - Street 1:1019 WICKER ST
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1039
Mailing Address - Country:US
Mailing Address - Phone:518-585-3700
Mailing Address - Fax:518-585-2576
Practice Address - Street 1:1019 WICKER ST
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1039
Practice Address - Country:US
Practice Address - Phone:518-585-3700
Practice Address - Fax:518-585-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1527300314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012427OtherEMPIRE BLUE CROSS
NY00311115Medicaid
NY000400518001OtherBLUESHIELD NENY
NY012427OtherEMPIRE BLUE CROSS