1019 Wicker Street Operating Company, LLC
NPI #1871035485 in Ticonderoga, New York
Provider Information
- NPI Number
- 1871035485
- Entity Type
- Organization
- Organization Name
- 1019 Wicker Street Operating Company, LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Nov 14, 2016
- Last Updated
- Jan 19, 2023
Practice Location
- Address
- 1019 WICKER ST
- City
- Ticonderoga
- State
- New York
- ZIP Code
- 12883-1039
- Phone
- (518) 585-2831
Authorized Official
- Name
- JEFFREY RUBIN
- Title
- CO-CHIEF EXECUTIVE OFFICER
- Phone
- (716) 817-5075
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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