Provider Demographics
NPI:1912902610
Name:SENIOR CARE CONNECTION, INC.
Entity Type:Organization
Organization Name:SENIOR CARE CONNECTION, INC.
Other - Org Name:EDDY SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. /DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-382-3290
Mailing Address - Street 1:504 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-2414
Mailing Address - Country:US
Mailing Address - Phone:518-382-3290
Mailing Address - Fax:518-382-3398
Practice Address - Street 1:504 STATE ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2414
Practice Address - Country:US
Practice Address - Phone:518-382-3290
Practice Address - Fax:518-382-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1220L001302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01674982Medicaid
NY337411Medicare ID - Type Unspecified