Organization
LAKESIDE NURSING HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PATRICK M DEPTULA (ADMINISTRATOR)
(607) 273-8072
Entity
Organization
Contact information
Practice address
1229 TRUMANSBURG ROAD, ITHACA, NY 14850-1313
(607) 273-8072
(607) 273-0373
Mailing address
1229 TRUMANSBURG RD, ITHACA, NY 14850-1313
(607) 273-8072
(607) 273-0373
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
5401307N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000900083000
HEALTH NOW
NY
05
—
00308181
—
NY
Enumeration date
04/12/2007
Last updated
08/22/2020
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