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General NPI Number Information
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NPI Number | 1568891810
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Entity Type | Organization
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Legal Business Name | MEMORY GARDEN AT TANGLEWOOD MANOR, INC
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location 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 |
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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 |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | TERRI INGERSOLL
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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 | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 060F040
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License Number State | NY
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