Basic Information
| Provider Information | |||||||||
| NPI: | 1831207257 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RENSSELAER PLANNING LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | EVERGREEN COMMONS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1070 LUTHER ROAD | ||||||||
| Address2: | |||||||||
| City: | EAST GREENBUSH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184794662 | ||||||||
| FaxNumber: | 5184774465 | ||||||||
| Practice Location | |||||||||
| Address1: | 1070 LUTHER ROAD | ||||||||
| Address2: | |||||||||
| City: | EAST GREENBUSH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184794662 | ||||||||
| FaxNumber: | 5184774465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2006 | ||||||||
| LastUpdateDate: | 07/29/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CREGIN | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5184794662 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 4152303N | NY | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 00312276 | 05 | NY | MEDICAID |