Provider Demographics
NPI:1114924438
Name:MEADOWS AT WESTFALL INC
Entity Type:Organization
Organization Name:MEADOWS AT WESTFALL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DRADER
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:585-442-7960
Mailing Address - Street 1:5901 LAC DE VILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5600
Mailing Address - Country:US
Mailing Address - Phone:585-442-7960
Mailing Address - Fax:585-442-6984
Practice Address - Street 1:5901 LAC DE VILLE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5600
Practice Address - Country:US
Practice Address - Phone:585-442-7960
Practice Address - Fax:585-442-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2750306N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP015005951OtherSKILLED NURSING FACILITY
NY104634CIOtherSKILLED NURSING FACILITY
NY51OtherSKILLED NURSING FACILITY
NYP0150059VDOtherSKILLED NURSING FACILITY
NY53OtherSKILLED NURSING FACILITY
NY01534225Medicaid
NY01534225Medicaid
NYP0150059VDOtherSKILLED NURSING FACILITY
NY335778001Medicare Oscar/Certification