1194992602 NPI number — STONEHEDGE ACQUISITION ROME LLC ADC

Table of content: (NPI 1194992602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194992602 NPI number — STONEHEDGE ACQUISITION ROME LLC ADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STONEHEDGE ACQUISITION ROME LLC ADC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STONEHEDGE HEALTH ADULT DAY CARE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194992602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 N JAMES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROME
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13440-3524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-533-1600
Provider Business Mailing Address Fax Number:
315-337-7359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 N JAMES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13440-3524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-533-1600
Provider Business Practice Location Address Fax Number:
315-337-7359
Provider Enumeration Date:
05/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STRAUSS
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
718-215-6000

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  3201309N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02005365 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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