Healthcare Provider Details

I. General information

NPI: 1619282704
Provider Name (Legal Business Name): BEVERWYCK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 AUTUMN DR
SLINGERLANDS NY
12159-9347
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-451-2107
  • Fax: 518-482-0106
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: COURTNEY KNOWLES
Title or Position: CREDENTIALING/ENROLLMENT MANAGER
Credential:
Phone: 518-525-5634