Basic Information
| Provider Information | |||||||||
| NPI: | 1053303784 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JENNIE B. RICHMOND CHAFFEE NURSING HOME COMPANY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141411443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165922871 | ||||||||
| FaxNumber: | 7165928103 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141411443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165922871 | ||||||||
| FaxNumber: | 7165928103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 04/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | SORICELLI | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7165922871 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1427000N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 00475278 | 05 | NY | MEDICAID | 140 | 01 | NY | BC/BS OF WNY | OTHER | 00011457901 | 01 | NY | UNIVERA HEALTHCARE | OTHER | R4 | 01 | NY | INDEPENDENT HEALTH | OTHER |