Provider Demographics
NPI:1245384189
Name:WELLS NURSING HOME, INC
Entity Type:Organization
Organization Name:WELLS NURSING HOME, INC
Other - Org Name:WELLS HOUSE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:E
Authorized Official - Last Name:VANSLYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-762-4546
Mailing Address - Street 1:201 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2806
Mailing Address - Country:US
Mailing Address - Phone:518-762-4548
Mailing Address - Fax:518-736-1570
Practice Address - Street 1:201 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2806
Practice Address - Country:US
Practice Address - Phone:518-762-4548
Practice Address - Fax:518-736-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1702300N225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0039494849Medicaid
NY007964OtherEMPIRE BLUECROSS
NYGRP490087001OtherBLUESHIELD OF NENY
NY1797OtherCDPHP
NY43015OtherMVP