Provider Demographics
NPI:1639116791
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:HARBOUR 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 1:1205 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:716-885-3838
Practice Address - Fax:716-885-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1401329N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00475205Medicaid
NY335640Medicare Oscar/Certification
1212680002Medicare NSC