Healthcare Provider Details

I. General information

NPI: 1245384189
Provider Name (Legal Business Name): WELLS NURSING HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MADISON AVE
JOHNSTOWN NY
12095-2806
US

IV. Provider business mailing address

201 W MADISON AVE
JOHNSTOWN NY
12095-2806
US

V. Phone/Fax

Practice location:
  • Phone: 518-762-4548
  • Fax: 518-736-1570
Mailing address:
  • Phone: 518-762-4548
  • Fax: 518-736-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1702300N
License Number StateNY

VIII. Authorized Official

Name: MR. NEAL E. VANSLYKE
Title or Position: ADMINISTRATOR
Credential:
Phone: 518-762-4546