Provider Demographics
NPI:1639255250
Name:CHAUTAUQUA HOSPICE AND PALLIATIVE CARE
Entity Type:Organization
Organization Name:CHAUTAUQUA HOSPICE AND PALLIATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TESTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-338-0033
Mailing Address - Street 1:20 WEST FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14750-1702
Mailing Address - Country:US
Mailing Address - Phone:716-338-0033
Mailing Address - Fax:716-338-1575
Practice Address - Street 1:20 WEST FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750-1702
Practice Address - Country:US
Practice Address - Phone:716-338-0033
Practice Address - Fax:716-338-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0622501F251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01406284Medicaid
561OtherBLUE CROSS
00011476301OtherUNIVERA
NY01406284Medicaid