Healthcare Provider Details

I. General information

NPI: 1740768506
Provider Name (Legal Business Name): GRAND BATAVIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 STATE ST
BATAVIA NY
14020-1044
US

IV. Provider business mailing address

1720 WHITESTONE EXPY STE 500
WHITESTONE NY
11357-3021
US

V. Phone/Fax

Practice location:
  • Phone: 718-215-6000
  • Fax:
Mailing address:
  • Phone: 718-215-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JEREMY B STRAUSS
Title or Position: CEO
Credential:
Phone: 718-215-6000