Provider Demographics
NPI:1962523092
Name:VAN ALLEN OPERATING CO., LLC
Entity type:Organization
Organization Name:VAN ALLEN OPERATING CO., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR MEDICARE SPEC
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-823-1001
Mailing Address - Street 1:755 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-1624
Mailing Address - Country:US
Mailing Address - Phone:315-823-1001
Mailing Address - Fax:315-823-2418
Practice Address - Street 1:755 E MONROE ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NY
Practice Address - Zip Code:13365-1624
Practice Address - Country:US
Practice Address - Phone:315-823-1001
Practice Address - Fax:315-823-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
335586Medicare ID - Type Unspecified