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General NPI Number Information
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NPI Number | 1033449624
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Entity Type | Organization
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Legal Business Name | ST MARYS MANOR
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 291 NORTH ST
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City | BUFFALO
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State | NY
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Zip | 14201-1306
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Country | US
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Telephone | 716-923-4858
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Fax |
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Provider Business Mailing Address
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Address Line | 291 NORTH ST
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City | BUFFALO
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State | NY
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Zip | 14201-1306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SR. VP/CFO
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Name | JAMES A DUNLOP JR.
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Credential |
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Telephone | 716-862-2431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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