Provider Demographics
NPI:1902933799
Name:SENECA HILL MANOR ADULT DAY HEALTH CARE
Entity Type:Organization
Organization Name:SENECA HILL MANOR ADULT DAY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-349-5300
Mailing Address - Street 1:20 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6495
Mailing Address - Country:US
Mailing Address - Phone:315-349-5300
Mailing Address - Fax:315-349-5365
Practice Address - Street 1:20 MANOR DR
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6495
Practice Address - Country:US
Practice Address - Phone:315-349-5300
Practice Address - Fax:315-349-5365
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENECA HILL MANOR INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3702312N261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02069249Medicaid