Provider Demographics
NPI:1124180260
Name:CHAUTAUQUA COUNTY CHAPTER OF NYSARC INC.
Entity Type:Organization
Organization Name:CHAUTAUQUA COUNTY CHAPTER OF NYSARC INC.
Other - Org Name:THE RESOURCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-661-1412
Mailing Address - Street 1:200 DUNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2528
Mailing Address - Country:US
Mailing Address - Phone:716-661-1001
Mailing Address - Fax:
Practice Address - Street 1:27B GIFFORD AVE
Practice Address - Street 2:
Practice Address - City:CELORON
Practice Address - State:NY
Practice Address - Zip Code:14720
Practice Address - Country:US
Practice Address - Phone:716-483-1485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6069-493320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00979539Medicaid