MEDICARE: HUDSON VALLEY SENIOR RESIDENCE

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	310400000X	Assisted Living Facility	740E006	NY

General Provider Information

NPI Number	:	1740488725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON VALLEY SENIOR RESIDENCE

Provider Business Mailing Address
First Line	:	80 WASHINGTON AVENUE
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-4834
Country	:	US
Telephone Number	:	845-331-0630
Fax Number	:	845-331-8646

Provider Business Practice Location Address
First Line	:	80 WASHINGTON AVENUE
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-4834
Country	:	US
Telephone Number	:	845-331-0630
Fax Number	:	845-331-8646

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. LEELAND ARNOLD RASMASON
Credential	:
Telephone Number	:	845-331-0630

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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