MEDICARE: THE NOTTINGHAM RESIDENTIAL HEALTH CARE FACILITY

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	3353301N	NY
2	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1417931619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE NOTTINGHAM RESIDENTIAL HEALTH CARE FACILITY

Provider Business Mailing Address
First Line	:	1305 NOTTINGHAM ROAD
Second Line	:
City	:	JAMESVILLE
State	:	NY
Zip	:	13078-8790
Country	:	US
Telephone Number	:	315-446-0123
Fax Number	:	315-498-9073

Provider Business Practice Location Address
First Line	:	1305 NOTTINGHAM RD
Second Line	:
City	:	JAMESVILLE
State	:	NY
Zip	:	13078-8790
Country	:	US
Telephone Number	:	315-446-0123
Fax Number	:

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	MARIA JOHNSON
Credential	:
Telephone Number	:	315-413-3688

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	05/09/2016

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