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General NPI Number Information
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NPI Number | 1710371539
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Entity Type | Organization
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Legal Business Name | 73 NORTH OF GRANVILLE, INC.
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 73 NORTH ST
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City | GRANVILLE
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State | NY
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Zip | 12832-1136
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Country | US
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Telephone | 518-642-3476
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Fax | 518-642-3801
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Provider Business Mailing Address
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Address Line | 73 NORTH ST
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City | GRANVILLE
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State | NY
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Zip | 12832-1136
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Country | US
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Telephone | 518-642-3476
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Fax | 518-642-3801
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Authorized Official
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Title or Position | ADMINISTRATOR/ OWNER
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Name | DEBRA HOLLISTER PAUQUETTE
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Credential |
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Telephone | 518-642-3476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 760-F-014
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License Number State | NY
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