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General NPI Number Information
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NPI Number | 1184007809
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Entity Type | Organization
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Legal Business Name | ALICE HYDE MEDICAL CENTER
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 45 SIXTH ST
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City | MALONE
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State | NY
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Zip | 12953
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Country | US
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Telephone | 518-481-8401
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Fax | 518-481-8403
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Provider Business Mailing Address
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Address Line | 45 SIXTH ST
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City | MALONE
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State | NY
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Zip | 12953
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Country | US
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Telephone | 518-481-8401
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Fax | 518-481-8403
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Authorized Official
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Title or Position | ALP ADMINISTRATOR
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Name | MS. LORRAINE KOUROFSKY
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Credential |
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Telephone | 518-481-8401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 2461L001
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License Number State | NY
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