Provider Demographics
NPI:1528254620
Name:ALLEGANY REHABILITATION ASSOCIATES
Entity type:Organization
Organization Name:ALLEGANY REHABILITATION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAKOVAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-593-1919
Mailing Address - Street 1:4222 BOLIVAR RD
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-9332
Mailing Address - Country:US
Mailing Address - Phone:585-593-1655
Mailing Address - Fax:585-593-1868
Practice Address - Street 1:4222 BOLIVAR RD
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-9332
Practice Address - Country:US
Practice Address - Phone:585-593-1655
Practice Address - Fax:585-593-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00740423Medicaid