Healthcare Provider Details

I. General information

NPI: 1093101743
Provider Name (Legal Business Name): 1 BETHESDA DRIVE OPERATING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHESDA DR
HORNELL NY
14843-1048
US

IV. Provider business mailing address

500 SENECA ST STE 100
BUFFALO NY
14204-1963
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-6990
  • Fax:
Mailing address:
  • Phone: 716-633-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY RUBIN
Title or Position: CO-CHIEF EXECUTIVE OFFICER
Credential:
Phone: 716-817-5075