Basic Information
| Provider Information | |||||||||
| NPI: | 1376608679 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELANT AT GOSHEN, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 HARRIMAN DRIVE | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109242410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453601200 | ||||||||
| FaxNumber: | 8452913833 | ||||||||
| Practice Location | |||||||||
| Address1: | 46 HARRIMAN DRIVE | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109242410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453601200 | ||||||||
| FaxNumber: | 8452913833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 05/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | WHITNEY | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VP, CFO | ||||||||
| AuthorizedOfficialTelephone: | 8453601361 | ||||||||
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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 | 314000000X | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 314000000X | 3523302N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 009285721 | 05 | NY | MEDICAID |