Healthcare Provider Details

I. General information

NPI: 1164409801
Provider Name (Legal Business Name): GERRY NURSING HOME COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 ROUTE 60
GERRY NY
14740-9540
US

IV. Provider business mailing address

4570 ROUTE 60 PO BOX 351
GERRY NY
14740-9540
US

V. Phone/Fax

Practice location:
  • Phone: 716-985-4612
  • Fax: 716-985-4197
Mailing address:
  • Phone: 716-985-4612
  • Fax: 716-985-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0662300N
License Number StateNY

VIII. Authorized Official

Name: MS. KATHLEEN A. LYNCH
Title or Position: ADMINISTRATOR
Credential:
Phone: 716-985-4612