MEDICARE: KATHERINE LUTHER RESIDENTIAL HEALTHCARE & REHABILITATION CENTER, 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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1174480024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHERINE LUTHER RESIDENTIAL HEALTHCARE & REHABILITATION CENTER, INC

Provider Business Mailing Address
First Line	:	110 UTICA RD
Second Line	:
City	:	CLINTON
State	:	NY
Zip	:	13323-1548
Country	:	US
Telephone Number	:	315-235-7103
Fax Number	:	315-235-7200

Provider Business Practice Location Address
First Line	:	110 UTICA RD
Second Line	:
City	:	CLINTON
State	:	NY
Zip	:	13323-1548
Country	:	US
Telephone Number	:	315-235-7103
Fax Number	:	315-235-7200

Authorized Official
Title or Position	:	COMPTROLLER
Name	:	SANTINA MARIE BONACCI
Credential	:
Telephone Number	:	315-235-7114

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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