Provider Demographics
NPI:1558358846
Name:INTEGRATED CARE SYSTEMS, LLC
Entity Type:Organization
Organization Name:INTEGRATED CARE SYSTEMS, LLC
Other - Org Name:NEWFANE REHABILITATION & HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEPNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-514-5527
Mailing Address - Street 1:2709 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-9701
Mailing Address - Country:US
Mailing Address - Phone:716-778-7111
Mailing Address - Fax:716-778-9218
Practice Address - Street 1:2709 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108-9701
Practice Address - Country:US
Practice Address - Phone:716-778-7111
Practice Address - Fax:716-778-9218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3154302N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY231OtherBCBS WNY BILLING #
NY00011421001OtherUNIVERA BILLING #
NY05OtherIND. HEALTH BILLING #
NY01793439Medicaid
NY3154302NMedicaid
NY01793439Medicaid