Healthcare Provider Details

I. General information

NPI: 1255329348
Provider Name (Legal Business Name): BATAVIA NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 STATE ST
BATAVIA NY
14020-1044
US

IV. Provider business mailing address

257 STATE ST
BATAVIA NY
14020-1044
US

V. Phone/Fax

Practice location:
  • Phone: 716-634-7600
  • Fax: 716-633-3369
Mailing address:
  • Phone: 716-634-7600
  • Fax: 716-633-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1801306N
License Number StateNY

VIII. Authorized Official

Name: MR. MARC I KORN
Title or Position: OWNER
Credential:
Phone: 716-634-7600