Healthcare Provider Details

I. General information

NPI: 1336134287
Provider Name (Legal Business Name): STAMFORD HEALTH CARE SOCIETY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28652 STATE HIGHWAY 23
STAMFORD NY
12167-1712
US

IV. Provider business mailing address

28652 STATE HIGHWAY 23
STAMFORD NY
12167-1712
US

V. Phone/Fax

Practice location:
  • Phone: 607-652-7521
  • Fax: 607-652-3362
Mailing address:
  • Phone: 607-652-7521
  • Fax: 607-652-3362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1225000N
License Number StateNY

VIII. Authorized Official

Name: MS. PAMELA HARMON
Title or Position: ADMINISTRATOR
Credential:
Phone: 607-652-7521