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NPI Code Detail

MEDICARE: STONEHEDGE AQUISITION CHITTENANGO I, LLC

MEDICARE: STONEHEDGE AQUISITION CHITTENANGO I, LLC
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
1314000000XSkilled Nursing Facility2629302NNY

Other Identifiers

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

General Provider Information

NPI Number : 1477541084
Entity Type Code : Organization
Provider Name (Legal Business Name) : STONEHEDGE AQUISITION CHITTENANGO I, LLC
Provider Business Mailing Address
First Line : 386 RT 59
Second Line : SUITE 409
City : MONSEY
State : NY
Zip : 10952
Country : US
Telephone Number : 845-357-7666
Fax Number : 845-357-0727
Provider Business Practice Location Address
First Line : 331 RUSSELL ST
Second Line :
City : CHITTENANGO
State : NY
Zip : 13037-1201
Country : US
Telephone Number : 315-687-7255
Fax Number : 315-687-9169
Authorized Official
Title or Position : MANAGING PARTNER
Name : MR. JOSEPH ZUPNICK
Credential :
Telephone Number : 845-357-7666
Provider Enumeration Date : 10/07/2005
Last Update Date : 08/06/2007

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