MEDICARE: SCHOFIELD RESIDENCE 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	1404300N	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	286	OTHER	NY	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00011419601	OTHER	NY	UNIVERA
4	K5	OTHER	NY	INDEPENDENT HEALTH

General Provider Information

NPI Number	:	1871553537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHOFIELD RESIDENCE INC.

Provider Business Mailing Address
First Line	:	3333 ELMWOOD AVE
Second Line	:
City	:	KENMORE
State	:	NY
Zip	:	14217-1013
Country	:	US
Telephone Number	:	716-874-1566
Fax Number	:	716-874-6942

Provider Business Practice Location Address
First Line	:	3333 ELMWOOD AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14217-1013
Country	:	US
Telephone Number	:	716-874-1566
Fax Number	:	716-874-6942

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RANDY GERLACH
Credential	:
Telephone Number	:	716-874-1566

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	06/17/2020

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