Healthcare Provider Details

I. General information

NPI: 1285615682
Provider Name (Legal Business Name): SUSQUEHANNA NURSING & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 RIVERSIDE DR
JOHNSON CITY NY
13790-2727
US

IV. Provider business mailing address

282 RIVERSIDE DR
JOHNSON CITY NY
13790-2727
US

V. Phone/Fax

Practice location:
  • Phone: 607-729-9206
  • Fax: 607-797-3229
Mailing address:
  • Phone: 607-729-9206
  • Fax: 607-797-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0303307N
License Number StateNY

VIII. Authorized Official

Name: MR. RALPH ROSSO
Title or Position: CFO
Credential:
Phone: 716-829-1554