Basic Information
| Provider Information | |||||||||
| NPI: | 1003803271 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SENECA HEALTH CARE CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2987 SENECA ST | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142242648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168280500 | ||||||||
| FaxNumber: | 7168281377 | ||||||||
| Practice Location | |||||||||
| Address1: | 2987 SENECA ST | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142242648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168280500 | ||||||||
| FaxNumber: | 7168281377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 03/23/2012 | ||||||||
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| AuthorizedOfficialLastName: | POLANSKI | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7168280500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1474301N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 00475365 | 05 | NY | MEDICAID |