Healthcare Provider Details

I. General information

NPI: 1174510531
Provider Name (Legal Business Name): CAMPBELL HALL REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 KIERNAN RD
CAMPBELL HALL NY
10916-2200
US

IV. Provider business mailing address

23 KIERNAN RD
CAMPBELL HALL NY
10916-2200
US

V. Phone/Fax

Practice location:
  • Phone: 845-294-8154
  • Fax: 845-294-9651
Mailing address:
  • Phone: 845-294-8154
  • Fax: 845-294-9651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number00734294
License Number StateNY

VIII. Authorized Official

Name: MR. GERALD J WOOD
Title or Position: OFFICER
Credential: CPA
Phone: 516-409-0700