Healthcare Provider Details

I. General information

NPI: 1629702527
Provider Name (Legal Business Name): VS SERVICER AT BEACON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HASTINGS DR
BEACON NY
12508-2055
US

IV. Provider business mailing address

455 CAYUGA RD STE 200
CHEEKTOWAGA NY
14225-1300
US

V. Phone/Fax

Practice location:
  • Phone: 845-440-1600
  • Fax: 845-440-0622
Mailing address:
  • Phone: 716-829-1957
  • Fax: 716-634-1394

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. MICHAEL FARBENBLUM
Title or Position: OWNER
Credential:
Phone: 716-826-2010