FORT HUDSON NURSING CENTER, INC.

Business Information

Division Name	FORT HUDSON HOME CARE, INC.
Congressional District	21
State/Country of Incorporation	NY, USA
Activation Date	2024-04-10
Initial Registration Date	2011-07-19
Entity Start Date	2004-07-01
Fiscal Year End Close Date	Dec 31

Service Classifications

NAICS Codes

623110

Points of Contacts

Electronic Business
Title	PRIMARY POC
Name	JOHN COBURN
Role	CFO
Address	319 BROADWAY, FORT EDWARD, NY, 12828, 1221, USA
Title	ALTERNATE POC
Name	ANDREW CRUIKSHANK
Address	319 BROADWAY, FORT EDWARD, NY, 12828, 1221, USA

Government Business
Title	PRIMARY POC
Name	JOHN COBURN
Address	319 BROADWAY, FORT EDWARD, NY, 12828, 1221, USA
Title	ALTERNATE POC
Name	ANDREW CRUIKSHANK
Address	319 BROADWAY, FORT EDWARD, NY, 12828, 1221, USA

Past Performance	Information not Available

Contact Information

POC	JOHN COBURN
Phone	+1 518-747-2811
Fax	+1 518-747-2740
Address	319 BROADWAY, FORT EDWARD, NY, 12828 1221, UNITED STATES

Ownership of Offeror Information

Highest Level Owner	Information not Available

Immediate Level Owner	Information not Available

List of Offerors (0)	Information not Available

File	View Page
Three-digit plan number (PN)	003
Effective date of plan	2006-01-01
Business code	623000
Sponsor’s telephone number	5187472811
Plan sponsor’s address	319 UPPER BROADWAY, FORT EDWARD, NY, 12828

Signature of

Role	Plan administrator
Date	2013-05-21
Name of individual signing	JOHN COBURN
Role	Employer/plan sponsor
Date	2013-05-21
Name of individual signing	JOHN COBURN

File	View Page
Three-digit plan number (PN)	003
Effective date of plan	2006-01-01
Business code	623000
Sponsor’s telephone number	5187472811
Plan sponsor’s address	319 UPPER BROADWAY, FORT EDWARD, NY, 12828

Plan administrator’s name and address

Administrator’s EIN	200481583
Plan administrator’s name	FORT HUDSON NURSING CENTER, INC.
Plan administrator’s address	319 UPPER BROADWAY, FORT EDWARD, NY, 12828
Administrator’s telephone number	5187472811

Signature of

Role	Plan administrator
Date	2012-05-07
Name of individual signing	JOHN COBURN
Role	Employer/plan sponsor
Date	2012-05-07
Name of individual signing	JOHN COBURN

File	View Page
Three-digit plan number (PN)	003
Effective date of plan	2006-01-01
Business code	623000
Sponsor’s telephone number	5187472811
Plan sponsor’s address	319 UPPER BROADWAY, FORT EDWARD, NY, 12828

Plan administrator’s name and address

Administrator’s EIN	200481583
Plan administrator’s name	FORT HUDSON NURSING CENTER, INC.
Plan administrator’s address	319 UPPER BROADWAY, FORT EDWARD, NY, 12828
Administrator’s telephone number	5187472811

Signature of

Role	Plan administrator
Date	2011-04-04
Name of individual signing	JOHN COBURN
Role	Employer/plan sponsor
Date	2011-04-04
Name of individual signing	JOHN COBURN

File	View Page
Three-digit plan number (PN)	003
Effective date of plan	2006-01-01
Business code	623000
Sponsor’s telephone number	5187472811
Plan sponsor’s address	319 UPPER BROADWAY, FORT EDWARD, NY, 12828

Plan administrator’s name and address

Administrator’s EIN	200481583
Plan administrator’s name	FORT HUDSON NURSING CENTER, INC.
Plan administrator’s address	319 UPPER BROADWAY, FORT EDWARD, NY, 12828
Administrator’s telephone number	5187472811

Signature of

Role	Plan administrator
Date	2010-06-21
Name of individual signing	JOHN COBURN
Role	Employer/plan sponsor
Date	2010-06-21
Name of individual signing	JOHN COBURN

Unique Award Key	CONT_IDV_VA528BO0316_3600
Awarding Agency	Department of Veterans Affairs
Link	View Page

Description

Title	HHA ALBANY
NAICS Code	621610: HOME HEALTH CARE SERVICES
Product and Service Codes	Q401: NURSING SERVICES

Recipient Details

Recipient	FORT HUDSON NURSING CENTER, INC.
UEI	G2QAMWKMMNE3
Legacy DUNS	162735711
Recipient Address	UNITED STATES, 28 BROADWAY, FORT EDWARD, 128281919