Organization
EPISCOPAL CHURCH HOME & AFFILIATES LIFE CARE COMMUNITY, INC
Active
Other names
DBA Canterbury Woods
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT C. WALLACE (PRESIDENT/CEO)
(716) 929-5801
Entity
Organization
Contact information
Practice address
705 RENAISSANCE DR, WILLIAMSVILLE, NY 14221-8052
(716) 929-5800
(716) 929-5812
Mailing address
705 RENAISSANCE DR, WILLIAMSVILLE, NY 14221-8052
(716) 929-5800
(716) 929-5812
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1421305N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000384000
BC/BS OF WNY
NY
01
—
0003009001
UNIVERA HEALTHCARE
NY
05
—
02008395
—
NY
01
—
9U
INDEPENDENT HEALTH
NY
Enumeration date
09/23/2005
Last updated
01/31/2012
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