Provider Demographics
NPI:1942340112
Name:NIAGARA FRONTIER METHODIST HOME, INC. D/B/A BEECHWOOD RESIDENCE
Entity Type:Organization
Organization Name:NIAGARA FRONTIER METHODIST HOME, INC. D/B/A BEECHWOOD RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-504-1999
Mailing Address - Street 1:2235 MILLERSPORT HWY
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1219
Mailing Address - Country:US
Mailing Address - Phone:716-504-1999
Mailing Address - Fax:
Practice Address - Street 1:2235 MILLERSPORT HWY
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1219
Practice Address - Country:US
Practice Address - Phone:716-504-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1451303N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474346Medicaid
NY00474346Medicaid