Healthcare Provider Details

I. General information

NPI: 1386641199
Provider Name (Legal Business Name): TIOGA NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 N CHEMUNG ST
WAVERLY NY
14892-1211
US

IV. Provider business mailing address

37 N CHEMUNG ST
WAVERLY NY
14892-1211
US

V. Phone/Fax

Practice location:
  • Phone: 607-565-2861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5320300N
License Number StateNY

VIII. Authorized Official

Name: MARIA LANDY
Title or Position: NURSING HOME ADMINISTRATOR
Credential:
Phone: 607-565-6329