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NPI Code Detail

MEDICARE: 1 BETHESDA DRIVE OPERATING COMPANY, LLC

MEDICARE: 1 BETHESDA DRIVE 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
1261QA0600XAdult Day Care Clinic/Center
2314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1093101743
Entity Type Code : Organization
Provider Name (Legal Business Name) : 1 BETHESDA DRIVE 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 : 1 BETHESDA DR
Second Line :
City : HORNELL
State : NY
Zip : 14843-1048
Country : US
Telephone Number : 607-324-6990
Fax Number :
Authorized Official
Title or Position : CO-CHIEF EXECUTIVE OFFICER
Name : DR. JEFFREY RUBIN
Credential :
Telephone Number : 716-817-5075
Provider Enumeration Date : 04/09/2015
Last Update Date : 11/18/2024

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