Healthcare Provider Details

I. General information

NPI: 1205803889
Provider Name (Legal Business Name): ST JAMES MERCY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHESDA DR
HORNELL NY
14843-1048
US

IV. Provider business mailing address

411 CANISTEO ST
HORNELL NY
14843-2104
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-8000
  • Fax: 607-324-8198
Mailing address:
  • Phone: 607-324-8000
  • Fax: 607-324-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5002001H
License Number StateNY

VIII. Authorized Official

Name: MR. DAVID C CAPONE
Title or Position: VP/CHIEF FINANCIAL OFFICER
Credential:
Phone: 607-324-8113