Healthcare Provider Details

I. General information

NPI: 1760538599
Provider Name (Legal Business Name): COMMUNITY CARE OF WESTERN NEW YORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E MAIN ST
ALLEGANY NY
14706-1318
US

IV. Provider business mailing address

115 E MAIN ST
ALLEGANY NY
14706-1318
US

V. Phone/Fax

Practice location:
  • Phone: 716-372-2106
  • Fax: 716-372-1148
Mailing address:
  • Phone: 716-372-2106
  • Fax: 716-372-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1039L001
License Number StateNY

VIII. Authorized Official

Name: MRS. SUSAN NELSON
Title or Position: CFO
Credential:
Phone: 716-372-2106