MEDICARE: BROTHERS OF MERCY NURSING HOME COMPANY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	03A1672	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124089859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROTHERS OF MERCY NURSING HOME COMPANY INC

Provider Business Mailing Address
First Line	:	10570 BERGTOLD RD
Second Line	:
City	:	CLARENCE
State	:	NY
Zip	:	14031-2198
Country	:	US
Telephone Number	:	716-759-6985
Fax Number	:	716-759-2959

Provider Business Practice Location Address
First Line	:	10570 BERGTOLD RD
Second Line	:
City	:	CLARENCE
State	:	NY
Zip	:	14031-2198
Country	:	US
Telephone Number	:	716-759-6985
Fax Number	:	716-759-2959

Authorized Official
Title or Position	:	ITERIM ADMINISTRATOR
Name	:	MS. VALERIE KANE
Credential	:	LICENSE 05166
Telephone Number	:	716-759-6985

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	08/22/2020

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