Healthcare Provider Details

I. General information

NPI: 1275523482
Provider Name (Legal Business Name): COMMUNITY CARE OF WESTERN NEW YORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/26/2024
Certification Date: 07/18/2024
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 TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA SULLIVAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 716-372-2106