Provider Demographics
NPI:1730173808
Name:NYACK MANOR NURSING HOME
Entity type:Organization
Organization Name:NYACK MANOR NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SLEDZIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-382-2427
Mailing Address - Street 1:476 CHRISTIAN HERALD RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2230
Mailing Address - Country:US
Mailing Address - Phone:845-268-6861
Mailing Address - Fax:845-268-6861
Practice Address - Street 1:476 CHRISTIAN HERALD RD
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2230
Practice Address - Country:US
Practice Address - Phone:845-268-6861
Practice Address - Fax:845-268-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4350302N314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310816Medicaid
335365Medicare Oscar/Certification
NY00310816Medicaid