Healthcare Provider Details

I. General information

NPI: 1972663508
Provider Name (Legal Business Name): CENTER FOR DISABILITY SERVICE HOLDING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 HACKETT BLVD
ALBANY NY
12208-3420
US

IV. Provider business mailing address

314 S MANNING BLVD
ALBANY NY
12208-1708
US

V. Phone/Fax

Practice location:
  • Phone: 518-591-3323
  • Fax: 518-591-3320
Mailing address:
  • Phone: 518-437-5574
  • Fax: 518-437-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number00312441
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0101307N
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number00312441
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number0101307N
License Number StateNY

VIII. Authorized Official

Name: GREGROY J SORRENTINO
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO/TREASURER
Phone: 518-944-2104