Provider Demographics
NPI:1851638985
Name:CHAUTAUQUA COUNTY HOME
Entity Type:Organization
Organization Name:CHAUTAUQUA COUNTY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLWIG
Authorized Official - Suffix:
Authorized Official - Credentials:
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:14048-9610
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:14048-9610
Practice Address - Country:US
Practice Address - Phone:716-366-6400
Practice Address - Fax:716-366-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004729-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004729-1Medicaid