Provider Demographics
NPI:1629295720
Name:EPISCOPAL RESIDENTIAL HEALTH CARE FACILITY, INC.
Entity Type:Organization
Organization Name:EPISCOPAL RESIDENTIAL HEALTH CARE FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO AND VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JULIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-614-0666
Mailing Address - Street 1:24 RHODE ISLAND ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-2142
Mailing Address - Country:US
Mailing Address - Phone:716-614-0666
Mailing Address - Fax:716-614-0840
Practice Address - Street 1:24 RHODE ISLAND ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2142
Practice Address - Country:US
Practice Address - Phone:716-614-0666
Practice Address - Fax:716-614-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1401907L251E00000X
NY1401332N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00669416Medicaid
NY00707108Medicaid
NY00030238701OtherUNIVERA ID FOR LT
NY00475434Medicaid
NY0000033OtherADAP PROVIDER REGISTRATN
NY00475434Medicaid
NY00669416Medicaid