Provider Demographics
NPI:1295770683
Name:TROY NURSING AND REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:TROY NURSING AND REHABILITATION CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-346-9640
Mailing Address - Street 1:49 MARVIN AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-6425
Mailing Address - Country:US
Mailing Address - Phone:508-273-6646
Mailing Address - Fax:518-273-0168
Practice Address - Street 1:49 MARVIN AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-6425
Practice Address - Country:US
Practice Address - Phone:508-273-6646
Practice Address - Fax:518-273-0168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DMN MANAGEMENT SERVICES , LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4102312N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY302056OtherW
NY956381OtherMVP
NY10054923OtherCDPHP
NY00360467Medicaid
NY000400690009OtherB
NY007991OtherEMPIRE BC
NYE28154Medicare UPIN
NY302056OtherW
NY000400690009OtherB
NYD78424Medicare UPIN
NYH30427Medicare UPIN
NY335280Medicare ID - Type Unspecified