Basic Information
| Provider Information | |||||||||
| NPI: | 1831119122 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENWOOD RESIDENCES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 N FOREST RD | ||||||||
| Address2: | |||||||||
| City: | GETZVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140681527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166393311 | ||||||||
| FaxNumber: | 7166393309 | ||||||||
| Practice Location | |||||||||
| Address1: | 660 MINERAL SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142241018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168274060 | ||||||||
| FaxNumber: | 7168274063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CIOCCA-BRACISZEWSKI | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7168274060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | 8879430 | NY | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 01543535 | 05 | NY | MEDICAID |