Provider Demographics
NPI:1538242086
Name:PRESBYTERIAN HOME FOR CENTRAL NEW YORK, INC.
Entity type:Organization
Organization Name:PRESBYTERIAN HOME FOR CENTRAL NEW YORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-272-2201
Mailing Address - Street 1:PO BOX 1144
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-0710
Mailing Address - Country:US
Mailing Address - Phone:315-272-2201
Mailing Address - Fax:315-797-4547
Practice Address - Street 1:4290 MIDDLE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5314
Practice Address - Country:US
Practice Address - Phone:315-272-2201
Practice Address - Fax:315-797-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01077292Medicaid