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General NPI Number Information
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NPI Number | 1891890893
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Entity Type | Organization
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Legal Business Name | MENORAH CAMPUS ADULT HOME, INC.
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 2680 N FOREST RD
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City | GETZVILLE
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State | NY
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Zip | 14068-1556
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Country | US
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Telephone | 716-639-3311
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Fax | 716-639-3310
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Provider Business Mailing Address
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Address Line | 2680 N FOREST RD
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City | GETZVILLE
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State | NY
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Zip | 14068-1556
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Country | US
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Telephone |
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Fax | 716-639-3310
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARSHA FARBER
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Credential |
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Telephone | 716-639-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 240E141
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License Number State | NY
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