Provider Demographics
NPI:1205970415
Name:ELDERWOOD VILLAGE AT MAPLEWOOD
Entity type:Organization
Organization Name:ELDERWOOD VILLAGE AT MAPLEWOOD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-681-8631
Mailing Address - Street 1:229 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1528
Mailing Address - Country:US
Mailing Address - Phone:716-681-8631
Mailing Address - Fax:
Practice Address - Street 1:229 BENNETT RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1528
Practice Address - Country:US
Practice Address - Phone:716-681-8631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01681149Medicaid