Provider Demographics
NPI:1790781359
Name:COUNTY OF CHAUTAUQUA - A MUN CORP
Entity Type:Organization
Organization Name:COUNTY OF CHAUTAUQUA - A MUN CORP
Other - Org Name:CHAUTAUQUA COUNTY HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:716-366-6400
Mailing Address - Street 1:10836 TEMPLE RD
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-9611
Mailing Address - Country:US
Mailing Address - Phone:716-366-6400
Mailing Address - Fax:716-366-0114
Practice Address - Street 1:10836 TEMPLE RD
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-9611
Practice Address - Country:US
Practice Address - Phone:716-366-6400
Practice Address - Fax:716-366-0114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF CHAUTAUQUA - A MUN CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-28
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0601300N314000000X
332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001000303OtherBLUE CROSS/BLUE SHIELD
NY010052508OtherRAILROAD MEDICARE
NY00011468501OtherSENIOR CHOICE
NY00475145NYMedicaid
NY5SOtherINDEPENDENT HEALTH
NY5SOtherINDEPENDENT HEALTH
NY001000303OtherBLUE CROSS/BLUE SHIELD
NY335485Medicare Oscar/Certification