MEDICARE: ST TERESAS NURSING HOME 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	314000000X	Skilled Nursing Facility	3501302N	NY

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
2	3501302N	OTHER	NY	OPERATING CERTIFICATE

General Provider Information

NPI Number	:	1114921004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST TERESAS NURSING HOME INC

Provider Business Mailing Address
First Line	:	120 HIGHLAND AVE
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-4713
Country	:	US
Telephone Number	:	845-342-1033
Fax Number	:	845-344-5631

Provider Business Practice Location Address
First Line	:	120 HIGHLAND AVENUE
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940
Country	:	US
Telephone Number	:	845-342-1033
Fax Number	:	845-344-5631

Authorized Official
Title or Position	:	SRVP CFO
Name	:	ANNMARIE COVONE
Credential	:
Telephone Number	:	646-633-4702

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/26/2008

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Directions to “ST TERESAS NURSING HOME INC ” Practice Location

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