Healthcare Provider Details

I. General information

NPI: 1396742482
Provider Name (Legal Business Name): SYRACUSE HOME ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7740 MEIGS RD
BALDWINSVILLE NY
13027-9757
US

IV. Provider business mailing address

7740 MEIGS RD
BALDWINSVILLE NY
13027-9757
US

V. Phone/Fax

Practice location:
  • Phone: 315-638-2521
  • Fax: 315-638-2552
Mailing address:
  • Phone: 315-638-2521
  • Fax: 315-638-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3327301N
License Number StateNY

VIII. Authorized Official

Name: MR. MARK MURPHY
Title or Position: ADMINISTRATOR
Credential:
Phone: 315-638-2521