Healthcare Provider Details

I. General information

NPI: 1013902972
Provider Name (Legal Business Name): GUILDERLAND LTC MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 MAIN ST.
GUILDERLAND CENTER NY
12085
US

IV. Provider business mailing address

PO BOX 9022
NISKAYUNA NY
12309
US

V. Phone/Fax

Practice location:
  • Phone: 518-861-5141
  • Fax: 518-861-6529
Mailing address:
  • Phone: 518-382-2427
  • Fax: 518-382-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0155300N
License Number StateNY

VIII. Authorized Official

Name: MS. CHRISTINE E SLEDZIEWSKI
Title or Position: CONTROLLER
Credential:
Phone: 518-382-2427