Provider Demographics
NPI:1518010875
Name:WELLS NURSING HOME INC.
Entity Type:Organization
Organization Name:WELLS NURSING HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DYGERT
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:518-762-4546
Mailing Address - Fax:518-736-1507
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:518-762-4546
Practice Address - Fax:518-736-1507
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLS NURSING HOME INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1702300N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000401871001OtherBLUESHIELD OF NENY
NY007964OtherEMPIRE BLUECROSS
NY00394849Medicaid
NY43015OtherMVP
NYV500P-5020OtherVA
NY335314Medicare ID - Type Unspecified