Healthcare Provider Details

I. General information

NPI: 1629049994
Provider Name (Legal Business Name): KATHERINE LUTHER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 08/22/2020
Certification Date:
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: 315-853-2681
Mailing address:
  • Phone: 315-853-5515
  • Fax: 315-853-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3225302N
License Number StateNY

VIII. Authorized Official

Name: MR. CHRISTOPHER DURR
Title or Position: ADMINISTRATOR-SKILLED FACILITIES
Credential:
Phone: 315-235-7180