Healthcare Provider Details

I. General information

NPI: 1114913902
Provider Name (Legal Business Name): TOLSTOY FOUNDATION NURSING HOME COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE RD
VALLEY COTTAGE NY
10989-2339
US

IV. Provider business mailing address

100 LAKE RD
VALLEY COTTAGE NY
10989-2339
US

V. Phone/Fax

Practice location:
  • Phone: 845-268-6813
  • Fax: 845-268-7673
Mailing address:
  • Phone: 845-268-6813
  • Fax: 845-268-7673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4350301N
License Number StateNY

VIII. Authorized Official

Name: DOROTHY CORBETT
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 845-268-6813