Provider Demographics
NPI:1366448706
Name:GERRY HOMES INC
Entity Type:Organization
Organization Name:GERRY HOMES INC
Other - Org Name:HERITAGE PARK 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 360
Mailing Address - Street 2:
Mailing Address - City:GERRY
Mailing Address - State:NY
Mailing Address - Zip Code:14740-0360
Mailing Address - Country:US
Mailing Address - Phone:716-985-6813
Mailing Address - Fax:716-985-6607
Practice Address - Street 1:150 PRATHER AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6710
Practice Address - Country:US
Practice Address - Phone:716-488-1921
Practice Address - Fax:716-484-2933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0602310N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00030010001OtherSENIOR CHOICE PROVIDER
NY01520369Medicaid
NY81004AMedicare ID - Type UnspecifiedMEDICARE B PROVIDER #