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General NPI Number Information
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NPI Number | 1952306631
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Entity Type | Organization
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Legal Business Name | OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 4102 OLD VESTAL RD
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City | VESTAL
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State | NY
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Zip | 13850-3531
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Country | US
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Telephone | 607-772-1598
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Fax | 607-771-0669
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Provider Business Mailing Address
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Address Line | 4102 OLD VESTAL RD
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City | VESTAL
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State | NY
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Zip | 13850-3531
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Country | US
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Telephone | 607-772-1598
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Fax | 607-771-0669
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. ROCHELLE EGGLETON
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Credential | BSN, MBA
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Telephone | 607-772-1598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0301603
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License Number State | NY
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