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General NPI Number Information
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NPI Number | 1306499884
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Entity Type | Organization
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Legal Business Name | OLEAN MANOR INC
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 3260 N 7TH ST
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City | ALLEGANY
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State | NY
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Zip | 14706-9532
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Country | US
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Telephone | 716-543-4200
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Fax | 716-373-1850
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Provider Business Mailing Address
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Address Line | 560 FAIRMOUNT AVE
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City | JAMESTOWN
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State | NY
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Zip | 14701-2749
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Country | US
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Telephone | 716-483-2876
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Fax | 716-483-2832
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Authorized Official
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Title or Position | CFO
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Name | KAREN RUSSELL
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Credential |
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Telephone | 716-483-2876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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