Healthcare Provider Details

I. General information

NPI: 1801959275
Provider Name (Legal Business Name): LEATHERSTOCKING HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41861 STATE HIGHWAY 10
DELHI NY
13753-3203
US

IV. Provider business mailing address

41861 STATE HIGHWAY 10
DELHI NY
13753-3203
US

V. Phone/Fax

Practice location:
  • Phone: 315-219-5548
  • Fax: 315-219-5549
Mailing address:
  • Phone: 315-219-5548
  • Fax: 315-219-5549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1254301N
License Number StateNY

VIII. Authorized Official

Name: MR. ERNEST ORTS
Title or Position: OWNER
Credential:
Phone: 315-219-5548