Provider Demographics
NPI:1407255003
Name:OPAL CARE LLC
Entity Type:Organization
Organization Name:OPAL CARE LLC
Other - Org Name:EMERALD SOUTH NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EILI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-885-6733
Mailing Address - Street 1:1175 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1175 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1401
Practice Address - Country:US
Practice Address - Phone:716-885-6733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00475407Medicaid
335593Medicare Oscar/Certification