Provider Demographics
NPI:1548334683
Name:NYSARC NIAGARA COUNTY CHAPTER
Entity type:Organization
Organization Name:NYSARC NIAGARA COUNTY CHAPTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:A
Authorized Official - Middle Name:LYNELL
Authorized Official - Last Name:NARKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-504-2625
Mailing Address - Street 1:1555 FACTORY OUTLET BLVD
Mailing Address - Street 2:PO BOX 360
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1798
Mailing Address - Country:US
Mailing Address - Phone:716-297-6400
Mailing Address - Fax:716-504-2624
Practice Address - Street 1:115 MEAD ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4408
Practice Address - Country:US
Practice Address - Phone:716-297-6400
Practice Address - Fax:716-504-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6116462OtherOPERATING CERTIFICATE
NY02175708Medicaid