MEDICARE: WEDGEWOOD NURSING HOME, INC.

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	2722301	NY

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	:	1811992944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEDGEWOOD NURSING HOME, INC.

Provider Business Mailing Address
First Line	:	740 EAST AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-2107
Country	:	US
Telephone Number	:	585-244-0410
Fax Number	:	585-244-1374

Provider Business Practice Location Address
First Line	:	5 CHURCH ST
Second Line	:
City	:	SPENCERPORT
State	:	NY
Zip	:	14559-1343
Country	:	US
Telephone Number	:	585-352-4810
Fax Number	:	585-352-1032

Authorized Official
Title or Position	:	CFO
Name	:	MR. DENNIS L MART
Credential	:
Telephone Number	:	585-244-0410

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/03/2011

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