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NPI Code Detail

MEDICARE: LUTHERAN HOME OF CENTRAL NEW YORK

MEDICARE: LUTHERAN HOME OF CENTRAL NEW YORK
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
1261QA0600XAdult Day Care Clinic/Center
2311ZA0620XAdult Care Home Facility510-E-007NY

General Provider Information

NPI Number : 1669551438
Entity Type Code : Organization
Provider Name (Legal Business Name) : LUTHERAN HOME OF CENTRAL NEW YORK
Provider Business Mailing Address
First Line : 108 UTICA RD
Second Line :
City : CLINTON
State : NY
Zip : 13323-1548
Country : US
Telephone Number : 315-235-7142
Fax Number :
Provider Business Practice Location Address
First Line : 108 UTICA RD
Second Line :
City : CLINTON
State : NY
Zip : 13323-1548
Country : US
Telephone Number : 315-235-7142
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : MS. MICHELLE KOHL
Credential :
Telephone Number : 315-235-7141
Provider Enumeration Date : 11/03/2006
Last Update Date : 07/31/2025

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Directions to “LUTHERAN HOME OF CENTRAL NEW YORK ” Practice Location

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