Healthcare Provider Details

I. General information

NPI: 1538397211
Provider Name (Legal Business Name): MVNH ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 6TH AVE
ILION NY
13357-1527
US

IV. Provider business mailing address

99 6TH AVE
ILION NY
13357-1527
US

V. Phone/Fax

Practice location:
  • Phone: 315-895-4050
  • Fax:
Mailing address:
  • Phone: 315-895-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2101300N
License Number StateNY

VIII. Authorized Official

Name: MR. GERALD JOHN WOOD III
Title or Position: CFO
Credential: CPA
Phone: 516-679-1500