Provider Demographics
NPI:1093865388
Name:GRACE MANOR HEALTH CARE FACILITY INC.
Entity type:Organization
Organization Name:GRACE MANOR HEALTH CARE FACILITY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-884-2474
Mailing Address - Street 1:10 SYMPHONY CIR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1339
Mailing Address - Country:US
Mailing Address - Phone:716-884-2474
Mailing Address - Fax:716-881-1470
Practice Address - Street 1:10 SYMPHONY CIR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1339
Practice Address - Country:US
Practice Address - Phone:716-884-2474
Practice Address - Fax:716-881-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01804553Medicaid
NY01804553Medicaid