Healthcare Provider Details

I. General information

NPI: 1669467296
Provider Name (Legal Business Name): NAZARETH HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 NORTH ST
BUFFALO NY
14201-1306
US

IV. Provider business mailing address

291 NORTH ST
BUFFALO NY
14201-1306
US

V. Phone/Fax

Practice location:
  • Phone: 716-604-1826
  • Fax: 716-604-1810
Mailing address:
  • Phone: 716-604-1826
  • Fax: 716-604-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1401315N
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1401315N
License Number StateNY

VIII. Authorized Official

Name: JAMES A DUNLOP CRONE
Title or Position: SR VP FINANCE/CFO
Credential:
Phone: 716-862-2431