# HERITAGE VILLAGE REHAB AND SKILLED NURSING INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710062112
- **Authorized official:** MATTHEW BOSWELL (VICE PRESIDENT OF FINANCE)
- **Authorized official phone:** (716) 338-9766

## Contact information

- **Practice address:** 4600 ROUTE 60, GERRY, NY 14740-9562
- **Practice address phone:** (716) 985-4649
- **Practice address fax:** (716) 985-6638
- **Mailing address:** 4600 ROUTE 60, GERRY, NY 14740-9562
- **Mailing address phone:** (716) 985-4649
- **Mailing address fax:** (716) 985-6638

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 28815 | NY | Yes |

## Other

- **Enumeration date:** 10/25/2006
- **Last updated:** 07/13/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3317357 | NCPDP | NY |