Healthcare Provider Details

I. General information

NPI: 1831119122
Provider Name (Legal Business Name): GREENWOOD RESIDENCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 MINERAL SPRINGS RD
WEST SENECA NY
14224-1018
US

IV. Provider business mailing address

2700 N FOREST RD
GETZVILLE NY
14068-1527
US

V. Phone/Fax

Practice location:
  • Phone: 716-827-4060
  • Fax: 716-827-4063
Mailing address:
  • Phone: 716-639-3311
  • Fax: 716-639-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number8879430
License Number StateNY

VIII. Authorized Official

Name: MS. PATRICIA CIOCCA-BRACISZEWSKI
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 716-827-4060