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General NPI Number Information
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NPI Number | 1336246040
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Entity Type | Organization
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Legal Business Name | SHERIDAN MANOR LLC
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 2799 SHERIDAN DR
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City | TONAWANDA
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State | NY
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Zip | 14150-9463
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Country | US
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Telephone | 716-837-4466
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Fax |
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Provider Business Mailing Address
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Address Line | 163 S UNION RD
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6510
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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 | CFO
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Name | DAVID G ROSNER
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Credential |
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Telephone | 716-633-2961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1403303N
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License Number State | NY
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