Provider Demographics
NPI:1003819590
Name:NIAGARA GERIATRIC CENTER
Entity Type:Organization
Organization Name:NIAGARA GERIATRIC CENTER
Other - Org Name:NIAGARA REHABILIATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOBERT
Authorized Official - Suffix:
Authorized Official - Credentials:ADM
Authorized Official - Phone:716-282-1207
Mailing Address - Street 1:822 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1136
Mailing Address - Country:US
Mailing Address - Phone:716-282-1207
Mailing Address - Fax:716-282-4088
Practice Address - Street 1:822 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1136
Practice Address - Country:US
Practice Address - Phone:716-282-1207
Practice Address - Fax:716-282-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3102310N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00030097501OtherUNIVERA
NY00475030Medicaid
NY000000330000OtherBLUE CROSS BLUE SHIELD
NYD6OtherINDEPENDENT HEALTH
NY00475030Medicaid