Provider Demographics
NPI:1275806978
Name:580 ORCHARD PARK ROAD OPERATING COMPANY LLC
Entity Type:Organization
Organization Name:580 ORCHARD PARK ROAD OPERATING COMPANY LLC
Other - Org Name:ELDERWOOD ASSISTED LIVING AT WEST SENECA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-236-8712
Mailing Address - Street 1:641 LEXINGTON AVE
Mailing Address - Street 2:31ST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4503
Mailing Address - Country:US
Mailing Address - Phone:908-236-8712
Mailing Address - Fax:
Practice Address - Street 1:580 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2600
Practice Address - Country:US
Practice Address - Phone:716-677-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-12
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility