Healthcare Provider Details

I. General information

NPI: 1730173808
Provider Name (Legal Business Name): NYACK MANOR NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 CHRISTIAN HERALD RD
VALLEY COTTAGE NY
10989-2230
US

IV. Provider business mailing address

476 CHRISTIAN HERALD RD
VALLEY COTTAGE NY
10989-2230
US

V. Phone/Fax

Practice location:
  • Phone: 845-268-6861
  • Fax: 845-268-6861
Mailing address:
  • Phone: 845-268-6861
  • Fax: 845-268-6861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4350302N
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINE E SLEDZIEWSKI
Title or Position: CONTROLLER
Credential:
Phone: 518-382-2427