Healthcare Provider Details

I. General information

NPI: 1710264080
Provider Name (Legal Business Name): PHYLLIS CALLENDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 KNOLLVIEW DR
PAWLING NY
12564-1138
US

IV. Provider business mailing address

14 KNOLLVIEW DR
PAWLING NY
12564-1138
US

V. Phone/Fax

Practice location:
  • Phone: 347-721-6190
  • Fax:
Mailing address:
  • Phone: 347-721-6190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number289539-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PHYLLIS CALLENDER
Title or Position: LPN
Credential: LPN
Phone: 347-721-6190