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General NPI Number Information
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NPI Number | 1932302882
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Entity Type | Organization
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Legal Business Name | TANGLEWOOD MANOR, INC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 560 FAIRMOUNT AVENUE
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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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Provider Business Mailing Address
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Address Line | 560 FAIRMOUNT AVENUE
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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 | ADMINISTRATOR
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Name | TERRI L INGERSOLL
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Credential | C.O.O.
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 03A1922
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License Number State | NY
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