Healthcare Provider Details

I. General information

NPI: 1467534974
Provider Name (Legal Business Name): ST. LUKE RESIDENTIAL HEALTH CARE FACILITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 E RIVER RD
OSWEGO NY
13126-6400
US

IV. Provider business mailing address

299 E RIVER RD
OSWEGO NY
13126-6400
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-3166
  • Fax: 315-343-6531
Mailing address:
  • Phone: 315-342-3166
  • Fax: 315-343-6531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHELLY YOUNGS
Title or Position: CONTROLLER
Credential:
Phone: 315-342-3166