Healthcare Provider Details

I. General information

NPI: 1477754802
Provider Name (Legal Business Name): KATHERINE LUTHER RESIDENTIAL HEALTHCARE & REHABILITATION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
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: 315-853-5515
  • Fax: 315-853-4025
Mailing address:
  • Phone: 315-853-5515
  • Fax: 315-853-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ANDREW PETERSON
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 315-235-7101