Healthcare Provider Details

I. General information

NPI: 1417954959
Provider Name (Legal Business Name): COSDEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 LAFAYETTE ST
PALATINE BRIDGE NY
13428-9715
US

IV. Provider business mailing address

PO BOX 425
PALATINE BRIDGE NY
13428-0425
US

V. Phone/Fax

Practice location:
  • Phone: 518-673-5212
  • Fax: 518-673-5911
Mailing address:
  • Phone: 518-673-5212
  • Fax: 518-673-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2851301N
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2827000N
License Number StateNY

VIII. Authorized Official

Name: MRS. TAMMIE TOWSE
Title or Position: ADMINISTRATION
Credential:
Phone: 518-673-5212