Provider Demographics
NPI:1134116858
Name:ORCHARD MANOR INC.
Entity Type:Organization
Organization Name:ORCHARD MANOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-798-4100
Mailing Address - Street 1:600 BATES RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-9706
Mailing Address - Country:US
Mailing Address - Phone:585-798-4100
Mailing Address - Fax:585-798-5275
Practice Address - Street 1:600 BATES RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-9706
Practice Address - Country:US
Practice Address - Phone:585-798-4100
Practice Address - Fax:585-798-5275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3622302N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY355986Medicaid
NY355986Medicaid