Provider Demographics
NPI:1124492046
Name:CHAUTAUQUA ADULT DAY CARE CENTERS, INC
Entity type:Organization
Organization Name:CHAUTAUQUA ADULT DAY CARE CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BERCIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-665-4899
Mailing Address - Street 1:358 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5550
Mailing Address - Country:US
Mailing Address - Phone:716-665-4899
Mailing Address - Fax:716-665-4822
Practice Address - Street 1:358 E 5TH ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5550
Practice Address - Country:US
Practice Address - Phone:716-665-4866
Practice Address - Fax:716-665-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
02704589OtherMMIS