5775 Maelou Drive Operating Company LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

5775 MAELOU DRIVE OPERATING COMPANY LLC

Doing business as

Elderwood at Hamburg

Practice address

5775 Maelou Dr
Hamburg, NY 14075-7419

Phone

(716) 648-2820

NPI assigned

Feb 10, 2012

Last updated

Jan 19, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rebecca Kesten

Title

Paralegal

Phone

(917) 683-0267

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Elderwood at Hamburg Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205109949. Details of each certification follow.

• CCN 335679 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 335679

Legal name

5775 MAELOU DRIVE OPERATING COMPANY LLC

Doing business as

ELDERWOOD AT HAMBURG

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 21, 1985

Last certification

Jun 4, 2025

Beds

166

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Oct 12, 2011 in NY

Enrollment address

5775 Maelou Dr
Hamburg, NY 14075-7419

Nursing home name

ELDERWOOD AT HAMBURG

Affiliated entity

ELDERWOOD

Listed as

Elderwood at HamburgCCN 335679 · All quality measures

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

2 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jan 21, 1985

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

166128.7 residents per day on average

Chain

Elderwood17 facilities in the chain

Penalties (3 years)

1Fines totaling $16,900

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

5775 Maelou Drive Operating Company LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 5775 Maelou Drive Operating Company, LLC

  • Long Term Care Pharmacy
  • Hamburg, NY
  • NPI 1184058083
  NPD tax ID

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• 5775 Maelou Drive Operating Company, LLC

  • Long Term Care Pharmacy
  • Hamburg, NY
  • NPI 1184058083
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kent A Lieber, M. D.

  • Family Medicine Physician
  • Buffalo, NY
  • NPI 1265455109
  NPD (past)
• Ryan James Mikac, D.O.

  • Family Medicine Physician
  • Amherst, NY
  • NPI 1346502689
  NPD (past)

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Kent A Lieber, M. D.

  • Family Medicine Physician
  • Buffalo, NY
  • NPI 1265455109

  Nursing home

  Care Compare affiliation
• Ryan James Mikac, D.O.

  • Family Medicine Physician
  • Amherst, NY
  • NPI 1346502689

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1205109949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SENECA ST STE 100",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142041963",
            "telephone_number": "716-633-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5775 MAELOU DR",
            "city": "HAMBURG",
            "state": "NY",
            "postal_code": "140757419",
            "telephone_number": "716-648-2820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "5775 MAELOU DRIVE OPERATING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-10",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "KESTEN",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "PARALEGAL",
        "authorized_official_telephone_number": "917-683-0267"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00872028",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elderwood at Hamburg",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elderwood at Hamburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 5775 Maelou Drive Operating Company, LLC
• 716 Physical Therapy, PLLC
• 76 Buffalo Street Operating Company LLC (Elderwood Assisted Living at Hamburg)
• Nadia Aboley
• Lori Ann Abramowitz, MS

• Skilled Nursing Facility in Hamburg, NY
• Providers in Hamburg, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.