EVERGREEN VALLEY NURSING HOME
Adult Care Home
Plattsburgh, New York
Provider NPI: 1316033152
Organization Information:Organization Name: EVERGREEN VALLEY NURSING HOME
Practice Location:
8 BUSHEY BLVD PLATTSBURGH, NY 12901 US
Tel: 518-563-3261 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
8 BUSHEY BLVD PLATTSBURGH, NY 12901 US
Tel: 518-563-3261 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 311ZA0620X | Nursing & Custodial Care Facilities Custodial Care Facility Adult Care Home | NY | 0901301N |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
02329757 | NY | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin