Basic Information
| Provider Information | |||||||||
| NPI: | 1952309536 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALBANY COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 780 ALBANY SHAKER RD | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122111058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188692231 | ||||||||
| FaxNumber: | 5188691713 | ||||||||
| Practice Location | |||||||||
| Address1: | 780 ALBANY SHAKER RD | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122111058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188692231 | ||||||||
| FaxNumber: | 5188691290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 05/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | SLATKY | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5188692231 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LNHA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0153302N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0153302N | 01 | NY | NYSDOH CERTIFICATE LICENSE NUMBER | OTHER | 00309260 | 05 | NY | MEDICAID |