1366483836 NPI number — RIVER PARK HEALTHCARE CENTER, INC.

Table of content: (NPI 1366483836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366483836 NPI number — RIVER PARK HEALTHCARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVER PARK HEALTHCARE CENTER, 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:
THE WATERS OF ALLEGANY
Provider Other Organization Name Type Code:
3
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:
1366483836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 GLEED AVE
Provider Second Line Business Mailing Address:
THE PARK ASSOCIATES, INC
Provider Business Mailing Address City Name:
EAST AURORA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14052-2980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-652-2820
Provider Business Mailing Address Fax Number:
716-655-2320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5TH ST & MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLEGANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-373-2238
Provider Business Practice Location Address Fax Number:
716-373-2273
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
716-805-1474

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0420301N , 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: 000000309000 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00030050801 . This is a "UNIVERA PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3U . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02901531 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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