Provider Demographics
NPI:1124089859
Name:BROTHERS OF MERCY NURSING HOME COMPANY INC
Entity type:Organization
Organization Name:BROTHERS OF MERCY NURSING HOME COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ITERIM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE 05166
Authorized Official - Phone:716-759-6985
Mailing Address - Street 1:10570 BERGTOLD RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-2198
Mailing Address - Country:US
Mailing Address - Phone:716-759-6985
Mailing Address - Fax:716-759-2959
Practice Address - Street 1:10570 BERGTOLD RD
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-2198
Practice Address - Country:US
Practice Address - Phone:716-759-6985
Practice Address - Fax:716-759-2959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03A1672314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00312363Medicaid
NY00312363Medicaid