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General NPI Number Information
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NPI Number | 1871820076
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Entity Type | Organization
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Legal Business Name | CAYUGA RIDGE, LLC
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 02/23/2015
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Provider Practice Location Address
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Address Line | 1229 TRUMANSBURG ROAD
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City | ITHACA
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State | NY
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Zip | 14850-1313
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Country | US
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Telephone | 607-273-8072
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Fax | 607-273-0373
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Provider Business Mailing Address
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Address Line | 1229 TRUMANSBURG ROAD
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City | ITHACA
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State | NY
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Zip | 14850-1313
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Country | US
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Telephone | 607-273-8072
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Fax | 607-273-0373
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BRENDA BAKER
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Credential |
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Telephone | 607-273-0373
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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 | 5401311N
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License Number State | NY
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