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General NPI Number Information
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NPI Number | 1902068877
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Entity Type | Organization
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Legal Business Name | KINGSWAY MANOR LLC
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 357 KINGS RD
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City | SCHENECTADY
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State | NY
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Zip | 12304-3645
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Country | US
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Telephone | 518-393-4304
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Fax | 519-393-0749
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Provider Business Mailing Address
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Address Line | 357 KINGS RD
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City | SCHENECTADY
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State | NY
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Zip | 12304-3645
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Country | US
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Telephone | 518-393-4304
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Fax | 519-393-0749
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. MICHAEL MC PARTLON
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Credential |
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Telephone | 518-393-4117
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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 | 650-F-103
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License Number State | NY
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