Healthcare Provider Details

I. General information

NPI: 1194992602
Provider Name (Legal Business Name): STONEHEDGE ACQUISITION ROME LLC ADC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N JAMES ST
ROME NY
13440-3524
US

IV. Provider business mailing address

801 N JAMES ST
ROME NY
13440-3524
US

V. Phone/Fax

Practice location:
  • Phone: 315-533-1600
  • Fax: 315-337-7359
Mailing address:
  • Phone: 315-533-1600
  • Fax: 315-337-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3201309N
License Number StateNY

VIII. Authorized Official

Name: JEREMY STRAUSS
Title or Position: CEO
Credential:
Phone: 718-215-6000