Healthcare Provider Details

I. General information

NPI: 1932302882
Provider Name (Legal Business Name): TANGLEWOOD MANOR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 FAIRMOUNT AVENUE
JAMESTOWN NY
14701-2749
US

IV. Provider business mailing address

560 FAIRMOUNT AVENUE
JAMESTOWN NY
14701-2749
US

V. Phone/Fax

Practice location:
  • Phone: 716-483-2876
  • Fax: 716-483-2832
Mailing address:
  • Phone: 716-483-2876
  • Fax: 716-483-2832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number03A1922
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: TERRI L INGERSOLL
Title or Position: ADMINISTRATOR
Credential: C.O.O.
Phone: 716-483-2876