Organization
VICTORY LAKE OPERATIONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD J WOOD (OPERATOR)
(845) 229-9177
Entity
Organization
Contact information
Practice address
419 N QUAKER LN, HYDE PARK, NY 12538-2933
(845) 229-9177
(845) 229-2734
Mailing address
419 N QUAKER LN, HYDE PARK, NY 12538-2933
(845) 229-9177
(845) 229-2734
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
00308961
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00308961
—
NY
Enumeration date
09/30/2005
Last updated
01/15/2008
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