Healthcare Provider Details

I. General information

NPI: 1033027305
Provider Name (Legal Business Name): TAKOR ADULT RESIDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 OMEGA TER
LATHAM NY
12110-1954
US

IV. Provider business mailing address

27 OMEGA TER
LATHAM NY
12110-1954
US

V. Phone/Fax

Practice location:
  • Phone: 518-265-7863
  • Fax:
Mailing address:
  • Phone: 518-265-7863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ROSELINE TAKOR
Title or Position: CEO
Credential:
Phone: 518-265-7863