Provider Demographics
NPI:1013903657
Name:MCAULEY RESIDENCE
Entity type:Organization
Organization Name:MCAULEY RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:MACHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-828-2974
Mailing Address - Street 1:1503 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1339
Mailing Address - Country:US
Mailing Address - Phone:716-447-6600
Mailing Address - Fax:
Practice Address - Street 1:1503 MILITARY RD
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1339
Practice Address - Country:US
Practice Address - Phone:716-447-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1404000N313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV9OtherIHA
NY141OtherHEALTHNOW
NY57OtherIHA
NY00475287Medicaid
NY00011427302OtherUNIVERA
NY00475287Medicaid