Provider Demographics
NPI:1558406009
Name:ABSOLUT CENTER FOR NURSING AND REHABILITATION AT AURORA PARK, LLC
Entity Type:Organization
Organization Name:ABSOLUT CENTER FOR NURSING AND REHABILITATION AT AURORA PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-652-2820
Mailing Address - Street 1:300 GLEED AVE
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2980
Mailing Address - Country:US
Mailing Address - Phone:716-652-2820
Mailing Address - Fax:
Practice Address - Street 1:292 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1650
Practice Address - Country:US
Practice Address - Phone:716-652-1560
Practice Address - Fax:716-652-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1422303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011220402OtherUNIVERA/EXCELLUS
NYV7OtherINDEPENDENTHEALTHSUBACUTE
NY00463552Medicaid
NYV7OtherFAMILYCHOICE SUBACUTE
NYBA1021OtherMEDICARE CARRIER
NY7100413OtherUNITED HEALTHCARE
NYQ9OtherFAMILY CHOICESKILLED
NY000000281002OtherBLUE CROSS/BLUE SHIELD
Q9OtherINDEPENDENTHEALTH SKILLED
NY335281Medicare Oscar/Certification
NYJ400002306Medicare PIN
NYV7OtherFAMILYCHOICE SUBACUTE
NY7100413OtherUNITED HEALTHCARE
NYRB6396Medicare PIN
Q9OtherINDEPENDENTHEALTH SKILLED