1831119122 NPI number — GREENWOOD RESIDENCES, INC.

Table of Contents

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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