Healthcare Provider Details

I. General information

NPI: 1134116858
Provider Name (Legal Business Name): ORCHARD MANOR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BATES RD
MEDINA NY
14103-9706
US

IV. Provider business mailing address

600 BATES RD
MEDINA NY
14103-9706
US

V. Phone/Fax

Practice location:
  • Phone: 585-798-4100
  • Fax: 585-798-5275
Mailing address:
  • Phone: 585-798-4100
  • Fax: 585-798-5275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3622302N
License Number StateNY

VIII. Authorized Official

Name: MR. THOMAS E. MORIEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 585-798-4100