Healthcare Provider Details

I. General information

NPI: 1184626897
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BROAD ST
HAMILTON NY
13346-9575
US

IV. Provider business mailing address

150 BROAD ST
HAMILTON NY
13346-9575
US

V. Phone/Fax

Practice location:
  • Phone: 315-824-6082
  • Fax: 315-824-3182
Mailing address:
  • Phone: 315-824-6082
  • Fax: 315-824-3182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2625000N
License Number StateNY

VIII. Authorized Official

Name: SEAN FADALE
Title or Position: CEO
Credential:
Phone: 315-824-6082