Healthcare Provider Details

I. General information

NPI: 1467725168
Provider Name (Legal Business Name): 200 BASSETT ROAD OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2012
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BASSETT RD
WILLIAMSVILLE NY
14221-2639
US

IV. Provider business mailing address

500 SENECA ST STE 100
BUFFALO NY
14204-1963
US

V. Phone/Fax

Practice location:
  • Phone: 716-689-6681
  • Fax:
Mailing address:
  • Phone: 716-633-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: REBECCA GOLUB
Title or Position: PARALEGAL
Credential:
Phone: 917-683-0267