Organization
CGSR, INC
Active
Other names
Meadowbrook Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL F. RICHARDS (ADMINISTRATOR)
(518) 563-5440
Entity
Organization
Contact information
Practice address
154 PROSPECT AVE, PLATTSBURGH, NY 12901-1302
(518) 563-5440
(518) 563-1206
Mailing address
154 PROSPECT AVE, PLATTSBURGH, NY 12901-1302
(518) 563-5440
(518) 563-1206
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
314000000X
Skilled Nursing Facility
Primary
0901303N
NY
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0140
PFI
NY
05
—
02994732
—
NY
01
—
08-41529-7
NYS EMPLOYER ID
NY
01
—
0901303N
OPERATING CERTIFICATE NUM
NY
Enumeration date
05/24/2005
Last updated
12/31/2019
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