Provider Demographics
NPI:1194902544
Name:FRANCISCAN HEALTH SUPPORT, INC
Entity type:Organization
Organization Name:FRANCISCAN HEALTH SUPPORT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:CARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-458-3600
Mailing Address - Street 1:333 BUTTERNUT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DE WITT
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2141
Mailing Address - Country:US
Mailing Address - Phone:315-458-3600
Mailing Address - Fax:315-458-2760
Practice Address - Street 1:300 GATEWAY PARK DR
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-3755
Practice Address - Country:US
Practice Address - Phone:315-458-3200
Practice Address - Fax:315-452-9502
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN HEALTH SUPPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-29
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03379980Medicaid
NY0457050004Medicare NSC