Provider Demographics
NPI:1861487498
Name:WNY CATHOLIC LONG TERM CARE, INC.
Entity Type:Organization
Organization Name:WNY CATHOLIC LONG TERM CARE, INC.
Other - Org Name:FATHER BAKER MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUNLOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-862-2431
Mailing Address - Street 1:6400 POWERS RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-4841
Mailing Address - Country:US
Mailing Address - Phone:716-667-0001
Mailing Address - Fax:716-667-0028
Practice Address - Street 1:6400 POWERS RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-4841
Practice Address - Country:US
Practice Address - Phone:716-667-0001
Practice Address - Fax:716-667-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1435302N313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16OtherIHA
NY01487076Medicaid
NY00011455101OtherUNIVERA
NY332OtherHEALTHNOW
NYD7OtherIHA
NY332OtherHEALTHNOW