Provider Demographics
NPI:1992766265
Name:NIAGARA LUTHERAN HOME AND REHABILITATION CENTER.INC.
Entity type:Organization
Organization Name:NIAGARA LUTHERAN HOME AND REHABILITATION CENTER.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JANKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-684-0202
Mailing Address - Street 1:5959 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9523
Mailing Address - Country:US
Mailing Address - Phone:716-684-0202
Mailing Address - Fax:716-206-0484
Practice Address - Street 1:64 HAGER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-1327
Practice Address - Country:US
Practice Address - Phone:716-886-4377
Practice Address - Fax:716-886-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00475338Medicaid
33-5164Medicare ID - Type Unspecified