Healthcare Provider Details

I. General information

NPI: 1255344842
Provider Name (Legal Business Name): ELDERWOOD SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BENNETT RD
CHEEKTOWAGA NY
14227-1528
US

IV. Provider business mailing address

1142 WEHRLE DR
WILLIAMSVILLE NY
14221-7748
US

V. Phone/Fax

Practice location:
  • Phone: 716-681-9480
  • Fax: 716-631-8732
Mailing address:
  • Phone: 716-631-3381
  • Fax: 716-631-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number025363
License Number StateNY

VIII. Authorized Official

Name: MARK LUDWIG
Title or Position: DIRECTOR
Credential:
Phone: 716-631-3381