Healthcare Provider Details

I. General information

NPI: 1518010875
Provider Name (Legal Business Name): WELLS NURSING HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
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: 518-762-4546
  • Fax: 518-736-1507
Mailing address:
  • Phone: 518-762-4546
  • Fax: 518-736-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1702300N
License Number StateNY

VIII. Authorized Official

Name: MICHELE A DYGERT
Title or Position: CFO
Credential:
Phone: 518-762-4546