Basic Information
| Provider Information | |||||||||
| NPI: | 1619004439 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABSOLUT CENTER FOR NURSING AND REHABILITATION AT THREE RIVERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 GLEED AVE | ||||||||
| Address2: | |||||||||
| City: | EAST AURORA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140522980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166872833 | ||||||||
| FaxNumber: | 7166872933 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 CREEKSIDE DR | ||||||||
| Address2: | |||||||||
| City: | PAINTED POST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148709208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6079364108 | ||||||||
| FaxNumber: | 6079363641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 11/17/2014 | ||||||||
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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 | 5026301N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 00705362 | 05 | NY | MEDICAID | 00030051002 | 01 | NY | EXCELLUS/RMSCO | OTHER | 7100412 | 01 | NY | UNITED HEALTHCARE | OTHER |