Provider Demographics
NPI:1275523482
Name:COMMUNITY CARE OF WESTERN NEW YORK, INC.
Entity type:Organization
Organization Name:COMMUNITY CARE OF WESTERN NEW YORK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-372-2106
Mailing Address - Street 1:115 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGANY
Mailing Address - State:NY
Mailing Address - Zip Code:14706-1318
Mailing Address - Country:US
Mailing Address - Phone:716-372-2106
Mailing Address - Fax:716-372-1148
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALLEGANY
Practice Address - State:NY
Practice Address - Zip Code:14706-1318
Practice Address - Country:US
Practice Address - Phone:716-372-2106
Practice Address - Fax:716-372-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01277590Medicaid
NY331549Medicare ID - Type Unspecified