Provider Demographics
NPI:1972963643
Name:MEADOWBROOK MANOR
Entity Type:Organization
Organization Name:MEADOWBROOK MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BIEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-520-0320
Mailing Address - Street 1:31 OSWEGO ST
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:NY
Mailing Address - Zip Code:13074-2115
Mailing Address - Country:US
Mailing Address - Phone:315-564-5555
Mailing Address - Fax:315-564-5033
Practice Address - Street 1:31 OSWEGO ST
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:NY
Practice Address - Zip Code:13074-2115
Practice Address - Country:US
Practice Address - Phone:315-564-5555
Practice Address - Fax:315-564-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home