Provider Demographics
NPI:1780077164
Name:LISA ARCANGEL
Entity type:Organization
Organization Name:LISA ARCANGEL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERD NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:716-997-6203
Mailing Address - Street 1:56 GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1407
Mailing Address - Country:US
Mailing Address - Phone:716-997-6203
Mailing Address - Fax:
Practice Address - Street 1:56 GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1407
Practice Address - Country:US
Practice Address - Phone:716-997-6203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LISA ARCANGEL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6168261311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRNMedicaid