Healthcare Provider Details

I. General information

NPI: 1164618500
Provider Name (Legal Business Name): LORETTO UTICA CTR ADHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 KEMBLE ST
UTICA NY
13501-4441
US

IV. Provider business mailing address

1445 KEMBLE ST
UTICA NY
13501-4441
US

V. Phone/Fax

Practice location:
  • Phone: 315-732-0100
  • Fax:
Mailing address:
  • Phone: 315-732-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number3202313N
License Number StateNY

VIII. Authorized Official

Name: MS. MICHELLE SYNAKOWSKI
Title or Position: EXECUTIVE
Credential: NHA
Phone: 315-732-0100