Healthcare Provider Details

I. General information

NPI: 1306499884
Provider Name (Legal Business Name): OLEAN MANOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 N 7TH ST
ALLEGANY NY
14706-9532
US

IV. Provider business mailing address

560 FAIRMOUNT AVE
JAMESTOWN NY
14701-2749
US

V. Phone/Fax

Practice location:
  • Phone: 716-543-4200
  • Fax: 716-373-1850
Mailing address:
  • Phone: 716-483-2876
  • Fax: 716-483-2832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KAREN RUSSELL
Title or Position: CFO
Credential:
Phone: 716-483-2876