MEDICARE: 2850 GRAND ISLAND BOULEVARD OPERATING COMPANY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013280759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2850 GRAND ISLAND BOULEVARD OPERATING COMPANY LLC

Provider Business Mailing Address
First Line	:	500 SENECA ST STE 100
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14204-1963
Country	:	US
Telephone Number	:	716-633-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 GRAND ISLAND BLVD
Second Line	:
City	:	GRAND ISLAND
State	:	NY
Zip	:	14072-1251
Country	:	US
Telephone Number	:	716-773-5900
Fax Number	:

Authorized Official
Title or Position	:	CO-CHIEF EXECUTIVE OFFICER
Name	:	DR. JEFFREY RUBIN
Credential	:
Telephone Number	:	716-817-5075

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	01/19/2023

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