Provider Demographics
NPI:1760437362
Name:GROTON COMMUNITY HEALTH CARE CENTER INC
Entity type:Organization
Organization Name:GROTON COMMUNITY HEALTH CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DEPTULA
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT/CEO
Authorized Official - Phone:607-898-5876
Mailing Address - Street 1:120 SYKES STREET
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073
Mailing Address - Country:US
Mailing Address - Phone:607-898-5876
Mailing Address - Fax:607-898-3034
Practice Address - Street 1:120 SYKES STREET
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:NY
Practice Address - Zip Code:13073
Practice Address - Country:US
Practice Address - Phone:607-898-5876
Practice Address - Fax:607-898-3034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00476971Medicaid
NY335658Medicare ID - Type Unspecified