Provider Demographics
NPI:1316048028
Name:MENORAH CAMPUS ADULT HOME, INC.
Entity type:Organization
Organization Name:MENORAH CAMPUS ADULT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY SERVICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-639-3311
Mailing Address - Street 1:2700 N FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1527
Mailing Address - Country:US
Mailing Address - Phone:716-639-3311
Mailing Address - Fax:716-369-3344
Practice Address - Street 1:2700 N FOREST RD
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1527
Practice Address - Country:US
Practice Address - Phone:716-639-3311
Practice Address - Fax:716-369-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9450L001Medicaid