Provider Demographics
NPI:1205961018
Name:BRIARWOOD MANOR, INC.
Entity type:Organization
Organization Name:BRIARWOOD MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERRERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-433-1513
Mailing Address - Street 1:1001 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-6142
Mailing Address - Country:US
Mailing Address - Phone:716-433-1513
Mailing Address - Fax:716-438-0919
Practice Address - Street 1:1001 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-6142
Practice Address - Country:US
Practice Address - Phone:716-433-1513
Practice Address - Fax:716-438-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500-F-092310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01441854Medicaid