Provider Demographics
NPI:1578911681
Name:SENECA LAKE TERRACE OPERATING, LLC
Entity Type:Organization
Organization Name:SENECA LAKE TERRACE OPERATING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-739-0795
Mailing Address - Street 1:3670 PRE EMPTION RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-9138
Mailing Address - Country:US
Mailing Address - Phone:315-789-4162
Mailing Address - Fax:315-781-1494
Practice Address - Street 1:3670 PRE EMPTION RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-9138
Practice Address - Country:US
Practice Address - Phone:315-789-4162
Practice Address - Fax:315-781-1494
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER SENIOR LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31040000X310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility