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General NPI Number Information
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NPI Number | 1528006939
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Entity Type | Organization
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Legal Business Name | COLLEGE PARK HEALTHCARE CENTER
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 9876 LUCKEY DR
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City | HOUGHTON
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State | NY
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Zip | 14744-8706
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Country | US
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Telephone | 585-567-2207
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Fax | 585-567-2730
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Provider Business Mailing Address
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Address Line | 300 GLEED AVE THE PARK ASSOCIATES, INC.
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City | EAST AURORA
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State | NY
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Zip | 14052-2980
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Country | US
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Telephone | 716-652-2820
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Fax | 716-655-2320
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Authorized Official
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Title or Position | TREASURER
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Name | MR. JOHN SMITH
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Credential |
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Telephone | 716-805-1474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0226301N
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License Number State | NY
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