Basic Information
| Provider Information | |||||||||
| NPI: | 1518094333 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABSOLUT CENTER FOR NURSING AND REHABILITATION AT ORCHARD PARK, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 GLEED AVE | ||||||||
| Address2: | |||||||||
| City: | EAST AURORA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140522980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166522820 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6060 ARMOR DUELLS RD | ||||||||
| Address2: | |||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141273126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166624433 | ||||||||
| FaxNumber: | 7166626752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 10/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHERMAN | ||||||||
| AuthorizedOfficialFirstName: | ISRAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7166522820 | ||||||||
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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 | 1435303N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 000000228002 | 01 | NY | BLUE CROSS/BLUE SHIELD | OTHER | R1 | 01 | NY | INDEPENDENTHEALTH SKILLED | OTHER | V8 | 01 | NY | INDEPENDENTHEALTHSUBACUTE | OTHER | R1 | 01 | NY | FAMILY CHOICE SKILLED | OTHER | 00764163 | 05 | NY | MEDICAID | 00011427502 | 01 | NY | UNIVERA/EXCELLUS | OTHER | V8 | 01 | NY | FAMILY CHOICE SUBACUTE | OTHER | 7100352 | 01 | NY | UNITED HEALTHCARE | OTHER |