Provider Demographics
NPI:1821486721
Name:HEATHWOOD ASSISTED LIVING AT PENFIELD, INC.
Entity Type:Organization
Organization Name:HEATHWOOD ASSISTED LIVING AT PENFIELD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-688-0111
Mailing Address - Street 1:100 ELDERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1765
Mailing Address - Country:US
Mailing Address - Phone:585-425-9663
Mailing Address - Fax:
Practice Address - Street 1:100 ELDERWOOD CT
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1765
Practice Address - Country:US
Practice Address - Phone:585-425-9663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility