Provider Demographics
NPI:1265645386
Name:ELDERWOOD VILLAGE AT WESTWOOD
Entity type:Organization
Organization Name:ELDERWOOD VILLAGE AT WESTWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-633-3900
Mailing Address - Street 1:580 ORCHARD PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2600
Mailing Address - Country:US
Mailing Address - Phone:716-677-4242
Mailing Address - Fax:716-677-0883
Practice Address - Street 1:580 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2600
Practice Address - Country:US
Practice Address - Phone:716-677-4242
Practice Address - Fax:716-677-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1171L001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02382034Medicaid