Healthcare Provider Details

I. General information

NPI: 1790781359
Provider Name (Legal Business Name): COUNTY OF CHAUTAUQUA - A MUN CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10836 TEMPLE RD
DUNKIRK NY
14048-9611
US

IV. Provider business mailing address

10836 TEMPLE RD
DUNKIRK NY
14048-9611
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-6400
  • Fax: 716-366-0114
Mailing address:
  • Phone: 716-366-6400
  • Fax: 716-366-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0601300N
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: ANDREA SNYDER
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 716-366-6400