Provider Demographics
NPI:1376087072
Name:CATHOLIC HEALTH SYSTEM
Entity Type:Organization
Organization Name:CATHOLIC HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHAB SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-923-4832
Mailing Address - Street 1:1495 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1339
Mailing Address - Country:US
Mailing Address - Phone:716-447-6037
Mailing Address - Fax:716-447-6575
Practice Address - Street 1:1495 MILITARY RD
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1339
Practice Address - Country:US
Practice Address - Phone:716-447-6037
Practice Address - Fax:716-447-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004961-1273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1770598104Medicaid
NY1770598104Medicaid
NY1770598104Medicare UPIN
NY1770598104Medicare NSC