MEDICARE: CAPITAL REGION GERIATRIC CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	0102001H	NY
2	282N00000X	General Acute Care Hospital	0102001N	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5613296	OTHER	NY	AETNA
2	10005796	OTHER	NY	CDPHP
3	000400101001	OTHER	NY	BLUE SHIELD OF NE NY
4	002990	OTHER	NY	BLUE CROSS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	102471	OTHER	NY	WELLCARE
7	92078	OTHER	NY	MOHAWK VALLEY PHYSICIANS

General Provider Information

NPI Number	:	1245287168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL REGION GERIATRIC CENTER, INC.

Provider Business Mailing Address
First Line	:	421 WEST COLUMBIA STREET
Second Line	:
City	:	COHOES
State	:	NY
Zip	:	12047-2217
Country	:	US
Telephone Number	:	518-237-5630
Fax Number	:	518-237-0904

Provider Business Practice Location Address
First Line	:	421 WEST COLUMBIA STREET
Second Line	:
City	:	COHOES
State	:	NY
Zip	:	12047-2217
Country	:	US
Telephone Number	:	518-237-5630
Fax Number	:	518-237-0904

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MS. JUANITA WHEELER
Credential	:
Telephone Number	:	518-238-4045

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/22/2020

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