Basic Information
| Provider Information | |||||||||
| NPI: | 1891890893 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MENORAH CAMPUS ADULT HOME, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2680 N FOREST RD | ||||||||
| Address2: | |||||||||
| City: | GETZVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140681556 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 7166393310 | ||||||||
| Practice Location | |||||||||
| Address1: | 2680 N FOREST RD | ||||||||
| Address2: | |||||||||
| City: | GETZVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140681556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166393311 | ||||||||
| FaxNumber: | 7166393310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FARBER | ||||||||
| AuthorizedOfficialFirstName: | MARSHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7166393311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | 240E141 | NY | Y | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
No ID Information.