MEDICARE: NYSARC 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6116462	OTHER	NY	OPERATING CERTIFICATE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548334683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYSARC NIAGARA COUNTY CHAPTER

Provider Business Mailing Address
First Line	:	1555 FACTORY OUTLET BLVD
Second Line	:	PO BOX 360
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-1798
Country	:	US
Telephone Number	:	716-297-6400
Fax Number	:	716-504-2624

Provider Business Practice Location Address
First Line	:	115 MEAD ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-4408
Country	:	US
Telephone Number	:	716-297-6400
Fax Number	:	716-504-2624

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MRS. A LYNELL NARKIEWICZ
Credential	:
Telephone Number	:	716-504-2625

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/22/2020

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