Healthcare Provider Details

I. General information

NPI: 1013443498
Provider Name (Legal Business Name): CLR GLENS FALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 UPPER SHERMAN AVE
GLENS FALLS NY
12804-2746
US

IV. Provider business mailing address

4770 WHITE PLAINS RD
BRONX NY
10470-1104
US

V. Phone/Fax

Practice location:
  • Phone: 518-793-2575
  • Fax: 518-793-0563
Mailing address:
  • Phone: 718-931-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5601306N
License Number StateNY

VIII. Authorized Official

Name: AMIR ABRAMCHIK
Title or Position: MEMBER
Credential:
Phone: 718-931-9700