Provider Demographics
NPI:1346599875
Name:2600 NIAGARA FALLS BOULEVARD AL OPERATING COMPANY, LLC
Entity Type:Organization
Organization Name:2600 NIAGARA FALLS BOULEVARD AL OPERATING COMPANY, LLC
Other - Org Name:ELDERWOOD ASSISTED LIVING AT WHEATFIELD
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:212-802-7609
Mailing Address - Street 1:641 LEXINGTON AVENUE
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:212-802-7609
Mailing Address - Fax:646-924-0520
Practice Address - Street 1:2600 NIAGARA FALLS BOULEVARD
Practice Address - Street 2:
Practice Address - City:WHEATFIELD
Practice Address - State:NY
Practice Address - Zip Code:14304-4560
Practice Address - Country:US
Practice Address - Phone:716-215-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500-F-101310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03382152Medicaid