Healthcare Provider Details

I. General information

NPI: 1831195270
Provider Name (Legal Business Name): HERITAGE VILLAGE REHAB & SKILLED NURSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 ROUTE 60
GERRY NY
14740-0367
US

IV. Provider business mailing address

4570 ROUTE 60 PO BOX 367
GERRY NY
14740-0367
US

V. Phone/Fax

Practice location:
  • Phone: 716-985-6700
  • Fax:
Mailing address:
  • Phone: 716-985-6811
  • Fax: 716-985-6607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0662300N
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNY

VIII. Authorized Official

Name: LISA HAGLUND
Title or Position: CEO
Credential:
Phone: 716-985-4612