Central New York Adult Homes Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

050-E-010 Issued in NY

Legal business name

CENTRAL NEW YORK ADULT HOMES INC

Doing business as

Evergreen Heights

Practice address

8939 Oakland St
Weedsport, NY 13166-9417

Phone

(315) 834-6142

Fax

(315) 834-8960

NPI assigned

Sep 15, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Thomas Carlson

Title

Executive Director

Phone

(315) 834-6142

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Evergreen Heights Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410739200000",
    "number": "1760883383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8939 OAKLAND ST",
            "city": "WEEDSPORT",
            "state": "NY",
            "postal_code": "131669417",
            "telephone_number": "315-834-6142",
            "fax_number": "315-834-8960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8939 OAKLAND ST",
            "city": "WEEDSPORT",
            "state": "NY",
            "postal_code": "131669417",
            "telephone_number": "315-834-6142",
            "fax_number": "315-834-8960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL NEW YORK ADULT HOMES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-15",
        "last_updated": "2014-09-15",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "315-834-6142",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NY",
            "license": "050-E-010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY IDENTIFICATION NUMBER",
            "identifier": "AF0158B",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE DEPARTMENT OF HEALTH OPERATING CERTIFICATE",
            "identifier": "050-E-010",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Heights",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joanne D Bigness, FHPNP
• Rebecca Jo Bigness, FNP-BC
• Karen C Borsz, M.S., CCC-SLP
• Cheryl Lynn Butler, LPN
• Jeremy M Carr
• Kelsi L Cole
• Alan R Cooper, D.C.
• Lisa Marie Eipp
• Phillip Lee Eipp, RN
• Shayla Espada, LPN

• Assisted Living Facility in Weedsport, NY
• Providers in Weedsport, NY by specialty
• Assisted Living Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.