Basic Information
| Provider Information | |||||||||
| NPI: | 1114913480 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RESURRECTION NURSING HOME | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CASTLETON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120331006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187327617 | ||||||||
| FaxNumber: | 5187324211 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CASTLETON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120331006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187327617 | ||||||||
| FaxNumber: | 5187324211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BELL | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5187327617 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.