Provider Demographics
NPI:1144883257
Name:ALLEGANY REGIONAL DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:ALLEGANY REGIONAL DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-945-4100
Mailing Address - Street 1:100 MAIN ST STE 11
Mailing Address - Street 2:
Mailing Address - City:SALAMANCA
Mailing Address - State:NY
Mailing Address - Zip Code:14779-1551
Mailing Address - Country:US
Mailing Address - Phone:716-945-4100
Mailing Address - Fax:716-945-4100
Practice Address - Street 1:100 MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-1551
Practice Address - Country:US
Practice Address - Phone:716-945-4100
Practice Address - Fax:716-945-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03043932Medicaid