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General NPI Number Information
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NPI Number | 1598197279
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Entity Type | Organization
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Legal Business Name | MEADOW BROOK TERRACE
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 21957 COLE RD
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City | CARTHAGE
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State | NY
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Zip | 13619-9622
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Country | US
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Telephone | 315-519-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 21957 COLE RD
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City | CARTHAGE
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State | NY
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Zip | 13619-9622
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Country | US
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Telephone | 315-519-7246
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOESPH W MILLARD
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Credential |
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Telephone | 315-519-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | NY
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