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General NPI Number Information
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NPI Number | 1760476568
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Entity Type | Organization
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Legal Business Name | PENN YAN MANOR NURSING HOME, INC.
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 655 LIBERTY ST
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City | PENN YAN
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State | NY
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Zip | 14527-1086
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Country | US
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Telephone | 315-536-2311
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Fax | 315-536-1033
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Provider Business Mailing Address
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Address Line | 655 LIBERTY ST
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City | PENN YAN
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State | NY
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Zip | 14527-1086
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Country | US
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Telephone | 315-536-2311
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Fax | 315-924-2906
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Authorized Official
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Title or Position | FISCAL MANAGER
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Name | JESSICA FISH
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Credential |
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Telephone | 315-536-2311
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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 | 6120300N
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License Number State | NY
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