Healthcare Provider Details

I. General information

NPI: 1124492046
Provider Name (Legal Business Name): CHAUTAUQUA ADULT DAY CARE CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 E 5TH ST
JAMESTOWN NY
14701-5550
US

IV. Provider business mailing address

358 E 5TH ST
JAMESTOWN NY
14701-5550
US

V. Phone/Fax

Practice location:
  • Phone: 716-665-4866
  • Fax: 716-665-4822
Mailing address:
  • Phone: 716-665-4899
  • Fax: 716-665-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRANK BERCIK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 716-665-4899