Provider Demographics
NPI:1174629489
Name:GOWANDA CORRECTIONAL FACILITY
Entity Type:Organization
Organization Name:GOWANDA CORRECTIONAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-532-0177
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:C/O PHARMACY
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-0350
Mailing Address - Country:US
Mailing Address - Phone:716-532-0177
Mailing Address - Fax:716-532-0177
Practice Address - Street 1:SOUTH ROAD
Practice Address - Street 2:C/O PHARMACY
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-0350
Practice Address - Country:US
Practice Address - Phone:716-532-0177
Practice Address - Fax:716-532-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022302311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility