Organization
ANGEL'S INN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FLOYD AUSTIN BRADLEY LHNA (ADMINISTRATOR)
(315) 782-2238
Entity
Organization
Contact information
Practice address
518 PINE ST, WATERTOWN, NY 13601-3235
(315) 782-2238
Mailing address
518 PINE ST, WATERTOWN, NY 13601-3235
(315) 782-2238
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
330F036
NY
376G00000X
Nursing Home Administrator
05684
NY
Other
Enumeration date
02/26/2016
Last updated
02/26/2016
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