NPIMap

Organization Active NPI

Our Lady of Lourdes Memorial Hospital Inc

  • Home Health Agency
  • Vestal, NY
National Provider Identifier
1124141981
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
0301902L Issued in NY
Legal business name
OUR LADY OF LOURDES MEMORIAL HOSPITAL INC
Practice address
4102 Vestal Rd
Vestal, NY 13850-3531
Phone
(607) 772-1598
Fax
(607) 771-0669
NPI assigned
Apr 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Rochelle Eggleton, BSN, MBA
Title
Director
Phone
(607) 772-1598

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 0301902L NY Primary

Addresses

Primary practice location

4102 Vestal Rd
Vestal, NY 13850-3531

Mailing address

4102 Vestal Rd
Vestal, NY 13850-3531
Phone (607) 772-1598

Other identifiers 1

IdentifierTypeStateIssuer
00337664MedicaidNY

Other names 1

  • Lourdes At Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
George F Henningiii12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4102 Vestal Rd
Vestal, NY 13850
Phone (607) 772-1598

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124141981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4102 VESTAL RD",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138503531",
            "telephone_number": "607-772-1598",
            "fax_number": "607-771-0669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4102 VESTAL RD",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138503531",
            "telephone_number": "607-772-1598",
            "fax_number": "607-771-0669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR LADY OF LOURDES MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EGGLETON",
        "authorized_official_first_name": "ROCHELLE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "607-772-1598",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BSN, MBA"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NY",
            "license": "0301902L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00337664",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lourdes At Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vestal, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.