Provider Demographics
NPI:1528015682
Name:PRESBYTERIAN SENIOR CARE OF WESTERN NEW YORK, INC.
Entity Type:Organization
Organization Name:PRESBYTERIAN SENIOR CARE OF WESTERN NEW YORK, INC.
Other - Org Name:HAWTHORN HEALTH MULTICARE CENTER FOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-631-0123
Mailing Address - Street 1:4455 TRANSIT RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6030
Mailing Address - Country:US
Mailing Address - Phone:716-631-0123
Mailing Address - Fax:716-631-5461
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:716-885-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1401323N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00475407Medicaid
335593Medicare Oscar/Certification
NY1212680001Medicare NSC