MEDICARE: HUDSON RIVER HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083778385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON RIVER HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	1200 BROWN ST
Second Line	:	4TH FLOOR - CREDENTIALING
City	:	PEEKSKILL
State	:	NY
Zip	:	10566-3617
Country	:	US
Telephone Number	:	914-734-8600
Fax Number	:	914-734-8745

Provider Business Practice Location Address
First Line	:	11 PILCH STREET
Second Line	:	HUDSON RIVER HEALTHCARE, INC.
City	:	PINE PLAINS
State	:	NY
Zip	:	12567
Country	:	US
Telephone Number	:	845-398-1100
Fax Number	:	845-398-7108

Authorized Official
Title or Position	:	CEO
Name	:	ANNE K. NOLON
Credential	:
Telephone Number	:	914-734-8747

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	05/02/2018

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