Organization
104 OLD NIAGARA ROAD OPERATING COMPANY, LLC
Active
Other names
Elderwood at Lockport
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY RUBIN (CO-CHIEF EXECUTIVE OFFICER)
(716) 817-5075
Entity
Organization
Contact information
Practice address
104 OLD NIAGARA RD, LOCKPORT, NY 14094-1500
(716) 434-8039
Mailing address
500 SENECA ST STE 100, BUFFALO, NY 14204-1963
(716) 633-3900
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00356372
—
NY
Enumeration date
04/05/2017
Last updated
01/19/2023
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