Basic Information
| Provider Information | |||||||||
| NPI: | 1083785968 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOLTS HOMES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | HERKIMER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133502028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158666964 | ||||||||
| FaxNumber: | 3158666760 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | HERKIMER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133502028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158666964 | ||||||||
| FaxNumber: | 3158666760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 10/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | REID | ||||||||
| AuthorizedOfficialFirstName: | RALPH | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3158666964 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | N | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 00311124 | 05 | NY | MEDICAID | 01414460 | 05 | NY | MEDICAID |