Healthcare Provider Details

I. General information

NPI: 1962670117
Provider Name (Legal Business Name): ELDERWOOD ADULT DAY CARE AT TIOGA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 03/12/2008
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: 607-565-6321
  • Fax: 607-565-6261
Mailing address:
  • Phone: 607-565-6321
  • Fax: 607-565-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5320301N
License Number StateNY

VIII. Authorized Official

Name: MRS. DARLENE GALE
Title or Position: DIRECTOR OF ACCOUNTS RECEIVABLE
Credential:
Phone: 716-250-1150