Healthcare Provider Details

I. General information

NPI: 1366483836
Provider Name (Legal Business Name): RIVER PARK HEALTHCARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH ST & MAPLE AVE
ALLEGANY NY
14706
US

IV. Provider business mailing address

300 GLEED AVE THE PARK ASSOCIATES, INC
EAST AURORA NY
14052-2980
US

V. Phone/Fax

Practice location:
  • Phone: 716-373-2238
  • Fax: 716-373-2273
Mailing address:
  • Phone: 716-652-2820
  • Fax: 716-655-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0420301N
License Number StateNY

VIII. Authorized Official

Name: MR. JOHN SMITH
Title or Position: TREASURER
Credential:
Phone: 716-805-1474