Organization
EVERGREEN VALLEY NURSING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EPHRAIM ZAGELBAUM (CEO)
(914) 597-7600
Entity
Organization
Contact information
Practice address
8 BUSHEY BLVD., PLATTSBURGH, NY 12901-3785
(518) 563-3261
(518) 562-1367
Mailing address
8 BUSHEY BLVD, MORRISONVILLE, NY 12901-3785
(518) 563-3261
(518) 562-1367
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0901301N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00308801
—
NY
05
—
02329757
—
NY
Enumeration date
09/29/2005
Last updated
09/21/2015
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