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General NPI Number Information
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NPI Number | 1467534974
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Entity Type | Organization
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Legal Business Name | ST. LUKE RESIDENTIAL HEALTH CARE FACILITY, INC.
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 299 E RIVER RD
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City | OSWEGO
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State | NY
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Zip | 13126-6400
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Country | US
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Telephone | 315-342-3166
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Fax | 315-343-6531
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Provider Business Mailing Address
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Address Line | 299 E RIVER RD
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City | OSWEGO
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State | NY
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Zip | 13126-6400
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Country | US
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Telephone | 315-342-3166
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Fax | 315-343-6531
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Authorized Official
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Title or Position | CONTROLLER
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Name | SHELLY YOUNGS
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Credential |
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Telephone | 315-342-3166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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