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NPI Code Detail

MEDICARE: 170 WEST AVENUE OPERATING COMPANY, LLC

MEDICARE: 170 WEST AVENUE 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1245784271
Entity Type Code : Organization
Provider Name (Legal Business Name) : 170 WEST AVENUE 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 : 170 WEST AVE
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1227
Country : US
Telephone Number : 585-395-6052
Fax Number :
Authorized Official
Title or Position : CO- CHIEF EXECUTIVE OFFICER
Name : DR. JEFFREY RUBIN
Credential :
Telephone Number : 716-817-5075
Provider Enumeration Date : 08/08/2016
Last Update Date : 01/19/2023

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