MEDICARE: ADIRONDACK TRI-COUNTY NURSING AND REHABILITATION 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	314000000X	Skilled Nursing Facility	5655302N	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578550042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADIRONDACK TRI-COUNTY NURSING AND REHABILITATION CENTER, INC

Provider Business Mailing Address
First Line	:	112 SKI BOWL ROAD
Second Line	:
City	:	NORTH CREEK
State	:	NY
Zip	:	12853
Country	:	US
Telephone Number	:	518-251-2447
Fax Number	:	518-251-4207

Provider Business Practice Location Address
First Line	:	112 SKI BOWL RD
Second Line	:
City	:	NORTH CREEK
State	:	NY
Zip	:	12853
Country	:	US
Telephone Number	:	518-251-2447
Fax Number	:	518-251-4207

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. HAL G PAYNE
Credential	:
Telephone Number	:	518-251-4712

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	06/16/2015

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