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Organization
WELLS NURSING HOME, INC
Active
Organization
WELLS NURSING HOME, INC
Active
Other names
Wells House Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NEAL E. VANSLYKE (ADMINISTRATOR)
(518) 762-4546
Entity
Organization
Contact information
Practice address
201 W MADISON AVE, JOHNSTOWN, NY 12095-2806
(518) 762-4548
(518) 736-1570
Mailing address
201 W MADISON AVE, JOHNSTOWN, NY 12095-2806
(518) 762-4548
(518) 736-1570
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1702300N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0039494849
—
NY
01
—
007964
EMPIRE BLUECROSS
NY
01
—
1797
CDPHP
NY
01
—
43015
MVP
NY
01
—
GRP490087001
BLUESHIELD OF NENY
NY
Enumeration date
01/22/2007
Last updated
08/22/2020
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