Basic Information
| Provider Information | |||||||||
| NPI: | 1912270455 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RSRNC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HILLCREST CTR | ||||||||
| Address2: | SUITE #225 | ||||||||
| City: | SPRING VALLEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109773740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453718100 | ||||||||
| FaxNumber: | 8453710010 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CASTLETON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120331006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187327617 | ||||||||
| FaxNumber: | 5187324732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2012 | ||||||||
| LastUpdateDate: | 02/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | STEIF | ||||||||
| AuthorizedOfficialFirstName: | EFRAIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8453718100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 4124300N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 335525 | 01 | NY | MEDICARE PROVIDER NO. | OTHER | 00473845 | 05 | NY | MEDICAID |