Provider Demographics
NPI:1932146933
Name:ARBOR PARK HEALTH CARE CENTER, INC
Entity Type:Organization
Organization Name:ARBOR PARK HEALTH CARE CENTER, INC
Other - Org Name:THE WATERS OF EDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-805-1474
Mailing Address - Street 1:300 GLEED AVE
Mailing Address - Street 2:CO THE PARK ASSOCIATES, INC.
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2980
Mailing Address - Country:US
Mailing Address - Phone:716-652-2820
Mailing Address - Fax:716-655-2320
Practice Address - Street 1:2806 GEORGE ST
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NY
Practice Address - Zip Code:14057-1205
Practice Address - Country:US
Practice Address - Phone:716-992-3987
Practice Address - Fax:716-992-2281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1461301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011438901OtherUNIVERA
NY000000225000OtherBLUE CROSS & BLUE SHIELD
NY01058777Medicaid
NY1VOtherINDEPENDENT HEALTH
NY335607Medicare Oscar/Certification
NY1VOtherINDEPENDENT HEALTH