Provider Demographics
NPI:1902523434
Name:EDRNC OPERATING LLC
Entity type:Organization
Organization Name:EDRNC OPERATING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ABE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-832-6899
Mailing Address - Street 1:2806 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14057-1205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2806 GEORGE ST
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NY
Practice Address - Zip Code:14057-1205
Practice Address - Country:US
Practice Address - Phone:716-992-3987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility