1629295720 NPI number — EPISCOPAL RESIDENTIAL HEALTH CARE FACILITY, INC.

Table of content: (NPI 1629295720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629295720 NPI number — EPISCOPAL RESIDENTIAL HEALTH CARE FACILITY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EPISCOPAL RESIDENTIAL HEALTH CARE FACILITY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629295720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 RHODE ISLAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14213-2142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-614-0666
Provider Business Mailing Address Fax Number:
716-614-0840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 RHODE ISLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14213-2142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-614-0666
Provider Business Practice Location Address Fax Number:
716-614-0840
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JULIANO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO AND VICE PRESIDENT
Authorized Official Telephone Number:
716-614-0666

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1401907L , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 314000000X , with the licence number: 1401332N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00669416 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00707108 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00030238701 . This is a "UNIVERA ID FOR LT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00475434 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000033 . This is a "ADAP PROVIDER REGISTRATN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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