Healthcare Provider Details

I. General information

NPI: 1740683226
Provider Name (Legal Business Name): HERITAGE MANOR OF RANSOMVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 RANSOMVILLE RD
RANSOMVILLE NY
14131-9602
US

IV. Provider business mailing address

3509 RANSOMVILLE RD
RANSOMVILLE NY
14131-9602
US

V. Phone/Fax

Practice location:
  • Phone: 716-791-4211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number2033L001
License Number StateNY

VIII. Authorized Official

Name: MR. DANNY ZYSKIND
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 716-791-4211