MEDICARE: NYSARC, INC. CATTARAUGUS-NIAGARA COUNTY CHAPTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1528564887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYSARC, INC. CATTARAUGUS-NIAGARA COUNTY CHAPTER

Provider Business Mailing Address
First Line	:	1439 BUFFALO ST
Second Line	:
City	:	OLEAN
State	:	NY
Zip	:	14760-1140
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 MEAD ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-4408
Country	:	US
Telephone Number	:	716-375-4747
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	BRENDA J THREEHOUSE
Credential	:
Telephone Number	:	716-375-4747

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	04/04/2018

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