Healthcare Provider Details

I. General information

NPI: 1003819590
Provider Name (Legal Business Name): NIAGARA GERIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 CEDAR AVE
NIAGARA FALLS NY
14301-1136
US

IV. Provider business mailing address

822 CEDAR AVE
NIAGARA FALLS NY
14301-1136
US

V. Phone/Fax

Practice location:
  • Phone: 716-282-1207
  • Fax: 716-282-4088
Mailing address:
  • Phone: 716-282-1207
  • Fax: 716-282-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3102310N
License Number StateNY

VIII. Authorized Official

Name: MR. THOMAS SCHOBERT
Title or Position: ADMINISTRATOR
Credential: ADM
Phone: 716-282-1207