Healthcare Provider Details

I. General information

NPI: 1760597678
Provider Name (Legal Business Name): ROSCOE COMMUNITY NURSING HOME CO., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 ROCKLAND ROAD
ROSCOE NY
12776
US

IV. Provider business mailing address

420 ROCKLAND ROAD
ROSCOE NY
12776
US

V. Phone/Fax

Practice location:
  • Phone: 607-498-4121
  • Fax: 607-498-5576
Mailing address:
  • Phone: 607-498-4121
  • Fax: 607-498-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number5262300N
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5262300N
License Number StateNY

VIII. Authorized Official

Name: MRS. JOY A WOOD
Title or Position: ADMINISTRATOR
Credential: RN BS
Phone: 607-498-4121