Healthcare Provider Details

I. General information

NPI: 1700884392
Provider Name (Legal Business Name): ANN LEE HOME AND INFIRMARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 WATERVLIET SHAKER RD
ALBANY NY
12211-1051
US

IV. Provider business mailing address

875 WATERVLIET SHAKER RD
ALBANY NY
12211-1051
US

V. Phone/Fax

Practice location:
  • Phone: 518-869-2231
  • Fax:
Mailing address:
  • Phone: 518-869-2231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0153303N
License Number StateNY

VIII. Authorized Official

Name: MR. THOMAS COFFEY
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 518-869-2231