Provider Demographics
NPI:1255765608
Name:LORD OF LIFE ADULT DAY HEALTH CENTER
Entity type:Organization
Organization Name:LORD OF LIFE ADULT DAY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GREGORIO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:716-668-8000
Mailing Address - Street 1:1025 BORDEN RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4604
Mailing Address - Country:US
Mailing Address - Phone:716-668-8000
Mailing Address - Fax:716-668-8058
Practice Address - Street 1:1025 BORDEN RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4604
Practice Address - Country:US
Practice Address - Phone:716-668-8000
Practice Address - Fax:716-668-8058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOLICENSE385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care