1861439747 NPI number — ORCHARD PARK HEALTHCARE CENTER, INC.

Table of content: (NPI 1861439747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861439747 NPI number — ORCHARD PARK HEALTHCARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORCHARD PARK HEALTHCARE CENTER, 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:
THE WATERS OF ORCHARD PARK
Provider Other Organization Name Type Code:
3
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:
1861439747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 GLEED AVE
Provider Second Line Business Mailing Address:
THE PARK ASSOCIATES, INC.
Provider Business Mailing Address City Name:
EAST AURORA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14052-2980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-652-2820
Provider Business Mailing Address Fax Number:
716-655-2320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6060 ARMOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORCHARD PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14127-3126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-662-4433
Provider Business Practice Location Address Fax Number:
716-662-6752
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
716-805-1474

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1435301N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000228000 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00764163 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00011427501 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: R1 . This is a "INDEPENDENT HEALTHSKILLED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: V8 . This is a "INDEPENDENTHEALTHSUBACUTE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com