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General NPI Number Information
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NPI Number | 1114921004
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Entity Type | Organization
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Legal Business Name | ST TERESAS NURSING HOME INC
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 120 HIGHLAND AVENUE
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City | MIDDLETOWN
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State | NY
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Zip | 10940
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Country | US
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Telephone | 845-342-1033
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Fax | 845-344-5631
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Provider Business Mailing Address
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Address Line | 120 HIGHLAND AVE
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City | MIDDLETOWN
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State | NY
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Zip | 10940-4713
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Country | US
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Telephone | 845-342-1033
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Fax | 845-344-5631
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Authorized Official
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Title or Position | SRVP CFO
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Name | ANNMARIE COVONE
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Credential |
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Telephone | 646-633-4702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 3501302N
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License Number State | NY
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