Provider Demographics
NPI:1831119122
Name:GREENWOOD RESIDENCES, INC.
Entity Type:Organization
Organization Name:GREENWOOD RESIDENCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CIOCCA-BRACISZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-827-4060
Mailing Address - Street 1:2700 N FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1527
Mailing Address - Country:US
Mailing Address - Phone:716-639-3311
Mailing Address - Fax:716-639-3309
Practice Address - Street 1:660 MINERAL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1018
Practice Address - Country:US
Practice Address - Phone:716-827-4060
Practice Address - Fax:716-827-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8879430320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01543535Medicaid