ST.DOMINIC'S HOME,INC
Intermediate Care Facility, Mentally Retarded
Blauvelt, New York
Provider NPI: 1942268818
Organization Information:Organization Name: ST.DOMINIC'S HOME,INC
Practice Location:
500 WESTERN HWY BLAUVELT, NY 10913 US
Tel: 845-359-3400 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:
500 WESTERN HWY BLAUVELT, NY 10913 US
Tel: 845-359-3400 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 315P00000X | Nursing & Custodial Care Facilities Intermediate Care Facility, Mentally Retarded | NY | 07159441 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
00475970 | NY | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin