Healthcare Provider Details

I. General information

NPI: 1568534717
Provider Name (Legal Business Name): COUNTY OF WAYNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 NYE RD
LYONS NY
14489-9111
US

IV. Provider business mailing address

1529 NYE RD
LYONS NY
14489-9111
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-5673
  • Fax: 315-946-5671
Mailing address:
  • Phone: 315-946-5673
  • Fax: 315-946-5671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5823302N
License Number StateNY

VIII. Authorized Official

Name: MR. DENIS VINNIK
Title or Position: ADMINISTRATOR
Credential:
Phone: 315-946-5673