1019 WICKER STREET OPERATING COMPANY, LLC (NPI# 1871035485) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871035485 |
| Entity Type | Organization |
| Organization Name | 1019 WICKER STREET OPERATING COMPANY, LLC |
| Other Organization Name | ELDERWOOD AT TICONDEROGA |
| Practice Address |
1019 Wicker St Ticonderoga NY 12883-1039 |
| Practice Telephone | 5185852831 |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2016-11-14 |
| Authorized Official Name | MR. BOB HEYERT (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 2128027603 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Elderwood at Ticonderoga | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | 1019 WICKER STREET OPERATING COMPANY, LLC | 80 State Street, Albany, Ny 12207 |
| Street Address |
1019 WICKER ST |
| City | TICONDEROGA |
| State | NY |
| Zip Code | 12883-1039 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801889746 | Moses Ludington Nursing Home Company, Inc | Skilled Nursing Facility | 1019 Wicker St, Ticonderoga, NY 12883-1039 | 2005-08-25 |
| 1457869224 | Ticonderoga Dental Plaza, PC | Dentist | 1019 Wicker St, Ticonderoga, NY 12883-1039 | 2018-01-16 |
| 1174905004 | Francine Brett Bassett | Nurse Practitioner | 1019 Wicker St, Ticonderoga, NY 12883-1039 | 2015-06-27 |
| 1972907749 | Hudson Headwaters Health Network | Family Medicine | 1019 Wicker St, Ticonderoga, NY 12883-1039 | 2014-10-22 |
| 1831592880 | Heather Winters | Physical Therapy Assistant | 1019 Wicker St, Ticonderoga, NY 12883-1039 | 2014-10-06 |
| 1710225313 | Sarah Jane Lapointe | Occupational Therapist | 1019 Wicker St, Ticonderoga, NY 12883-1039 | 2013-01-17 |
| 1013271550 | North Country Sports Medicine Pllc | Orthopaedic Surgery | 1019 Wicker St, Moses Ludington Hospital, Ticonderoga, NY 12883-1039 | 2012-06-29 |
| 1699056291 | Hudson Headwaters Health Network | Clinic/Center | 1019 Wicker St, Ticonderoga, NY 12883-1039 | 2011-09-09 |
| 1205124500 | Katherine K Shmulsky | Pharmacist | 1019 Wicker St, Ticonderoga, NY 12883-1039 | 2011-07-20 |
| 1780845164 | Prashant Malhotra | Physical Therapist | 1019 Wicker St, Ticonderoga, NY 12883-1039 | 2008-06-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528582822 | Walgreen Co | Pharmacy | 1161 Nys Route 9n, Ticonderoga, NY 12883 | 2017-07-28 |
| 1891233540 | Anne Kuhl | Specialist | 70 Lake George Ave, Ticonderoga, NY 12883 | 2017-02-02 |
| 1336697580 | Hayley Jean Woods | Pharmacist | 1161 Nys Rte 9n, Ticonderoga, NY 12883 | 2016-09-16 |
| 1962776153 | Linda L Leavens | Counselor | 166 Lord Howe St., Ticonderoga, NY 12883 | 2012-03-06 |
| 1093958084 | Diana J Eisenberg | Skilled Nursing Facility | 340 Burgoyne Road, Ticonderoga, NY 12883 | 2009-04-07 |
| 1386765881 | Dean Lewis Cook | Dentist | 3 Defiance St, Ticonderoga, NY 12883 | 2007-04-02 |
| 1902936941 | Susan B Malaney | Counselor | 5 Defiance Street, Ticonderoga, NY 12883 | 2007-03-07 |
| 1023182813 | Moses Ludington Hospital Pharmacy | Pharmacy | 1019 Wicker Street, Ticonderoga, NY 12883 | 2006-11-20 |
| 1336245083 | Ticonderoga Emergency Squad Inc | Ambulance | 118 Champlain Avenue, Ticonderoga, NY 12883 | 2006-09-16 |
| 1952319386 | Hudson Headwaters Health Network | Social Worker | 101 Adirondack Drive, Suite 2, Ticonderoga, NY 12883 | 2006-08-03 |
| Find all providers in zip 12883 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801889746 | Moses Ludington Nursing Home Company, Inc | Skilled Nursing Facility | 1019 Wicker St, Ticonderoga, NY 12883-1039 | 2005-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730701343 | Diamond Medical Employment Agency Inc | Skilled Nursing Facility | 21873 Hempstead Ave, Queens Village, NY 11429-2103 | 2020-05-18 |
| 1427670884 | Morris Park Rehabilitation and Nursing Center LLC | Skilled Nursing Facility | 1235 Pelham Parkway North, Bronx, NY 10469 | 2020-05-08 |
| 1659936334 | Nelson Tannis | Skilled Nursing Facility | 165 Broadway, New York, NY 10006-1404 | 2019-05-07 |
| 1295390029 | Westgate Operations Associates LLC | Skilled Nursing Facility | 525 Beahan Rd, Rochester, NY 14624-3403 | 2019-05-07 |
| 1952883423 | Roscoe Regional Healthcare LLC | Skilled Nursing Facility | 420 Rockland Rd, Roscoe, NY 12776-6450 | 2018-08-31 |
| 1164904769 | Renaissance Healthcare Group, LLC | Skilled Nursing Facility | 4975 Albany Post Rd, Staatsburg, NY 12580-6032 | 2018-08-30 |
| 1477049807 | Itkin Occupational Therapy PC | Skilled Nursing Facility | 134 Mackenzie Street, Brooklyn, NY 11235 | 2018-07-09 |
| 1699280826 | 239 Legris Avenue Operations LLC | Skilled Nursing Facility | 3118 Quentin Rd, Brooklyn, NY 11234-4235 | 2017-12-11 |
| 1376058578 | Yonkers Gardens, LLC | Skilled Nursing Facility | 115 S Broadway, Yonkers, NY 10701-4006 | 2017-12-10 |
| 1104355536 | Massapequa Center LLC | Skilled Nursing Facility | 101 Louden Ave., Amityville, NY 11701 | 2017-06-08 |
| Find all providers with the same taxonomy | ||||
| City | TICONDEROGA |
| Zip Code | 12883 |
Please comment or provide details below to improve the information on 1019 WICKER STREET OPERATING COMPANY, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.