Healthcare Provider Details

I. General information

NPI: 1023276128
Provider Name (Legal Business Name): CHAUTAUQUA COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 CENTRAL AVE
DUNKIRK NY
14048-2137
US

IV. Provider business mailing address

319 CENTRAL AVE
DUNKIRK NY
14048-2137
US

V. Phone/Fax

Practice location:
  • Phone: 716-363-3660
  • Fax:
Mailing address:
  • Phone: 716-363-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number22491089
License Number StateNY

VIII. Authorized Official

Name: ROBERT BERKE
Title or Position: INTERIM COMMISSIONER OF HEALTH SERV
Credential:
Phone: 716-363-3660