Provider Demographics
NPI:1588260228
Name:CLIFTON SPRINGS SANITARIUM CO
Entity type:Organization
Organization Name:CLIFTON SPRINGS SANITARIUM CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - PAYER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-0293
Mailing Address - Street 1:2 COULTER RD STE 1720
Mailing Address - Street 2:
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-1122
Mailing Address - Country:US
Mailing Address - Phone:315-318-0284
Mailing Address - Fax:
Practice Address - Street 1:2 COULTER RD STE 1720
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1122
Practice Address - Country:US
Practice Address - Phone:315-318-0284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLIFTON SPRINGS SANITARIUM CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental