Provider Demographics
NPI:1962670117
Name:ELDERWOOD ADULT DAY CARE AT TIOGA
Entity Type:Organization
Organization Name:ELDERWOOD ADULT DAY CARE AT TIOGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTS RECEIVABLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-250-1150
Mailing Address - Street 1:37 N CHEMUNG ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892-1211
Mailing Address - Country:US
Mailing Address - Phone:607-565-6321
Mailing Address - Fax:607-565-6261
Practice Address - Street 1:37 N CHEMUNG ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892-1211
Practice Address - Country:US
Practice Address - Phone:607-565-6321
Practice Address - Fax:607-565-6261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELDERWOOD HEALTH CARE AT TIOGA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-11
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5320301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01008020Medicaid