=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740488725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUDSON VALLEY SENIOR RESIDENCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 07/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 WASHINGTON AVENUE
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12401-4834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-331-0630
-----------------------------------------------------
Fax | 845-331-8646
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 80 WASHINGTON AVENUE
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12401-4834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-331-0630
-----------------------------------------------------
Fax | 845-331-8646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. LEELAND ARNOLD RASMASON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-331-0630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 740E006
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------