Basic Information
| Provider Information | |||||||||
| NPI: | 1700942042 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELANT AT GOSHEN INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ELANT AT GOSHEN INC LTHHCP | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 HARRIMAN DR | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109242410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452913700 | ||||||||
| FaxNumber: | 8452913833 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 CERONE PL | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125505104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452913700 | ||||||||
| FaxNumber: | 8452913833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | COVONE | ||||||||
| AuthorizedOfficialFirstName: | ANNMARIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP COMPTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 8452913759 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | NY | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 01999788 | 05 | NY | MEDICAID |