1861487498 NPI number — WNY CATHOLIC LONG TERM CARE, INC.

Table of content: (NPI 1861487498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861487498 NPI number — WNY CATHOLIC LONG TERM CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WNY CATHOLIC LONG TERM CARE, 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:
6
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:
1861487498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6400 POWERS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORCHARD PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14127-4841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-667-0001
Provider Business Mailing Address Fax Number:
716-667-0028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6400 POWERS 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:
14127-4841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-667-0001
Provider Business Practice Location Address Fax Number:
716-667-0028
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DUNLOP
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SR VP FINANCE/CFO
Authorized Official Telephone Number:
716-862-2431

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  1435302N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 1435302N , 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: 16 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01487076 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00011455101 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 332 . This is a "HEALTHNOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: D7 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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