1831119122 NPI number — GREENWOOD RESIDENCES, INC.

Table of content: (NPI 1831119122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831119122 NPI number — GREENWOOD RESIDENCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENWOOD RESIDENCES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831119122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 N FOREST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GETZVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14068-1527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-639-3311
Provider Business Mailing Address Fax Number:
716-639-3309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 MINERAL SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST SENECA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14224-1018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-827-4060
Provider Business Practice Location Address Fax Number:
716-827-4063
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CIOCCA-BRACISZEWSKI
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
716-827-4060

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  8879430 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01543535 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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