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General NPI Number Information
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NPI Number | 1700876836
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Entity Type | Organization
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Legal Business Name | ST. REGIS NURSING HOME & HEALTH RELATED FACILITY, INC.
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 89 GROVE ST
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City | MASSENA
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State | NY
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Zip | 13662-2615
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Country | US
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Telephone | 315-769-2494
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Fax | 315-769-3604
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Provider Business Mailing Address
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Address Line | 89 GROVE ST
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City | MASSENA
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State | NY
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Zip | 13662-2615
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Country | US
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Telephone | 315-769-2494
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Fax | 315-769-3604
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. WHEELER D MAYNARD JR.
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Credential | N.H.A.
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Telephone | 315-769-2494
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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 | 4402303N
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License Number State | NY
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