Healthcare Provider Details

I. General information

NPI: 1174480024
Provider Name (Legal Business Name): KATHERINE LUTHER RESIDENTIAL HEALTHCARE & REHABILITATION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 UTICA RD
CLINTON NY
13323-1548
US

IV. Provider business mailing address

110 UTICA RD
CLINTON NY
13323-1548
US

V. Phone/Fax

Practice location:
  • Phone: 315-235-7103
  • Fax: 315-235-7200
Mailing address:
  • Phone: 315-235-7103
  • Fax: 315-235-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANTINA MARIE BONACCI
Title or Position: COMPTROLLER
Credential:
Phone: 315-235-7114