Provider Demographics
NPI:1164409801
Name:GERRY NURSING HOME COMPANY
Entity Type:Organization
Organization Name:GERRY NURSING HOME COMPANY
Other - Org Name:HERITAGE VILLAGE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-985-4612
Mailing Address - Street 1:4570 ROUTE 60
Mailing Address - Street 2:PO BOX 351
Mailing Address - City:GERRY
Mailing Address - State:NY
Mailing Address - Zip Code:14740-9540
Mailing Address - Country:US
Mailing Address - Phone:716-985-4612
Mailing Address - Fax:716-985-4197
Practice Address - Street 1:4570 ROUTE 60
Practice Address - Street 2:
Practice Address - City:GERRY
Practice Address - State:NY
Practice Address - Zip Code:14740-9540
Practice Address - Country:US
Practice Address - Phone:716-985-4612
Practice Address - Fax:716-985-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0662300N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00356327Medicaid
NY335353Medicare ID - Type Unspecified