Healthcare Provider Details

I. General information

NPI: 1801089461
Provider Name (Legal Business Name): LORETTO HEALTH AND REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 INTREPID LN
SYRACUSE NY
13205-2548
US

IV. Provider business mailing address

700 E BRIGHTON AVE
SYRACUSE NY
13205-2201
US

V. Phone/Fax

Practice location:
  • Phone: 315-474-1478
  • Fax: 314-474-7413
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA JOHNSON
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 315-413-3688