Basic Information
| Provider Information | |||||||||
| NPI: | 1174297063 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMHERST SNF OPERATIONS LLC | ||||||||
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| OtherOrganizationName: | FAIRMONT CROSSING HEALTH AND REHAB CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1007 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | WOODMERE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115981246 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 173 BROCKMAN PARK DR | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245212583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349462850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2021 | ||||||||
| LastUpdateDate: | 11/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | LIEBERMAN | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCIAL OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5168555504 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.