Provider Demographics
NPI:1770655201
Name:FALLS HOME INC
Entity Type:Organization
Organization Name:FALLS HOME INC
Other - Org Name:THE FALLS HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:607-535-7165
Mailing Address - Street 1:111 SCHUYLER STREET
Mailing Address - Street 2:PO BOX 829
Mailing Address - City:MONTOUR FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14865-0829
Mailing Address - Country:US
Mailing Address - Phone:607-535-7165
Mailing Address - Fax:607-535-2511
Practice Address - Street 1:111 SCHUYLER STREET
Practice Address - Street 2:
Practice Address - City:MONTOUR FALLS
Practice Address - State:NY
Practice Address - Zip Code:14865-0829
Practice Address - Country:US
Practice Address - Phone:607-535-7165
Practice Address - Fax:607-535-2511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY670-F-004310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01432402Medicaid
NY02655489Medicaid