Healthcare Provider Details

I. General information

NPI: 1023055902
Provider Name (Legal Business Name): WOODLAND PARK HEALTHCARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 BROAD ST
SALAMANCA NY
14779-1424
US

IV. Provider business mailing address

300 GLEED AVE THE PARK ASSOCIATES, INC.
EAST AURORA NY
14052-2980
US

V. Phone/Fax

Practice location:
  • Phone: 716-945-1800
  • Fax: 716-945-5867
Mailing address:
  • Phone: 716-652-2820
  • Fax: 716-655-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0433302N
License Number StateNY

VIII. Authorized Official

Name: MR. JOHN SMITH
Title or Position: TREASURER
Credential:
Phone: 716-805-1474