Provider Demographics
NPI:1154592632
Name:BELVEDERE HEALTH SERVICES LLC.
Entity type:Organization
Organization Name:BELVEDERE HEALTH SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCCOOEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:518-694-9400
Mailing Address - Street 1:1 VAN TROMP ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-2213
Mailing Address - Country:US
Mailing Address - Phone:518-694-9400
Mailing Address - Fax:518-694-4419
Practice Address - Street 1:39 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-2824
Practice Address - Country:US
Practice Address - Phone:518-694-9400
Practice Address - Fax:518-694-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
NY310400000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02143057Medicaid
NY02738118Medicaid