Provider Demographics
NPI:1003812330
Name:GERRY HOMES INC
Entity Type:Organization
Organization Name:GERRY HOMES INC
Other - Org Name:HERITAGE GREEN REHAB & SKILLED NURSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-338-9766
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:GERRY
Mailing Address - State:NY
Mailing Address - Zip Code:14740-0365
Mailing Address - Country:US
Mailing Address - Phone:716-985-6812
Mailing Address - Fax:716-985-6607
Practice Address - Street 1:3023 ROUTE 430
Practice Address - Street 2:
Practice Address - City:GREENHURST
Practice Address - State:NY
Practice Address - Zip Code:14742-0400
Practice Address - Country:US
Practice Address - Phone:716-483-5000
Practice Address - Fax:716-488-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0658301N314000000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011450401OtherSENIOR CHOICE
NY01520350Medicaid
335721OtherMEDICARE PROVIDER NUMBER
NY81004AMedicare ID - Type UnspecifiedMEDICARE B PROVIDER
NY01520350Medicaid