Healthcare Provider Details

I. General information

NPI: 1720073539
Provider Name (Legal Business Name): OUR LADY OF PEACE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5285 LEWISTON RD
LEWISTON NY
14092-1942
US

IV. Provider business mailing address

5285 LEWISTON RD
LEWISTON NY
14092-1942
US

V. Phone/Fax

Practice location:
  • Phone: 716-298-2900
  • Fax: 716-298-2800
Mailing address:
  • Phone: 716-298-2900
  • Fax: 716-298-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3121303N
License Number StateNY

VIII. Authorized Official

Name: ERIN SHADBOLT
Title or Position: CEO
Credential:
Phone: 314-729-3500