Healthcare Provider Details

I. General information

NPI: 1124236005
Provider Name (Legal Business Name): NYSARC, INC., CATTARAUGUS COUNTY CHAPTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 BUFFALO ST
OLEAN NY
14760-1140
US

IV. Provider business mailing address

1439 BUFFALO ST
OLEAN NY
14760-1140
US

V. Phone/Fax

Practice location:
  • Phone: 716-375-4747
  • Fax: 716-375-4795
Mailing address:
  • Phone: 716-375-4747
  • Fax: 716-375-4795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number6067300
License Number StateNY

VIII. Authorized Official

Name: MELINDA E BUCKLEY
Title or Position: CFO
Credential:
Phone: 716-375-4747