Basic Information
| Provider Information | |||||||||
| NPI: | 1205096278 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GARNET HEALTH MEDICAL CENTER CATSKILLS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CATSKILL REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 68 HARRIS BUSHVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127013027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457943300 | ||||||||
| FaxNumber: | 8457941052 | ||||||||
| Practice Location | |||||||||
| Address1: | 68 HARRIS BUSHVILLE RD | ||||||||
| Address2: | |||||||||
| City: | HARRIS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457943300 | ||||||||
| FaxNumber: | 8457941052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2008 | ||||||||
| LastUpdateDate: | 06/02/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DAVISON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BUDGET, REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 8453337446 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 5263000H | NY | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 02978536 | 05 | NY | MEDICAID |