Provider Demographics
NPI:1932105053
Name:GERRY HOMES, INC
Entity Type:Organization
Organization Name:GERRY HOMES, INC
Other - Org Name:HERITAGE VILLAGE RETIREMENT CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-338-9766
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:GERRY
Mailing Address - State:NY
Mailing Address - Zip Code:14740-0350
Mailing Address - Country:US
Mailing Address - Phone:716-985-6823
Mailing Address - Fax:716-985-4148
Practice Address - Street 1:4600 ROUTE 60
Practice Address - Street 2:
Practice Address - City:GERRY
Practice Address - State:NY
Practice Address - Zip Code:14740-9562
Practice Address - Country:US
Practice Address - Phone:716-985-6823
Practice Address - Fax:716-985-6607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060-E036310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY81004AMedicare ID - Type UnspecifiedMEDICARE B