Healthcare Provider Details

I. General information

NPI: 1114913480
Provider Name (Legal Business Name): RESURRECTION NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 N MAIN ST
CASTLETON NY
12033-1006
US

IV. Provider business mailing address

90 N MAIN ST
CASTLETON NY
12033-1006
US

V. Phone/Fax

Practice location:
  • Phone: 518-732-7617
  • Fax: 518-732-4211
Mailing address:
  • Phone: 518-732-7617
  • Fax: 518-732-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. EDWARD BELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 518-732-7617