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Organization

FOUNDERS PAVILION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. DEBERA J. RANDALL (BUSINESS OFFICE REPRESENTIVE)
(607) 654-2407
Entity
Organization

Contact information

Practice address
205 E 1ST ST, CORNING, NY 14830-2809
(607) 654-2407
Mailing address
205 E 1ST ST, CORNING, NY 14830-2809
(607) 654-2407

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
207QG0300X
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01811994
NY
Enumeration date
12/23/2005
Last updated
07/29/2008
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