NPIMap

Organization Active NPI

Kaleida Health

Doing business as Degraff Memorial SNF

  • Adult Care Home Facility
  • North Tonawanda, NY
National Provider Identifier
1366489221
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
Legal business name
KALEIDA HEALTH
Doing business as
Degraff Memorial SNF
Practice address
445 Tremont St
North Tonawanda, NY 14120-6150
Phone
(716) 690-2077
NPI assigned
Jun 1, 2006
Last updated
Aug 22, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
KALEIDA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

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

Authorized official

Name
Angela H McCrorey
Title
Ar Manager
Phone
(716) 859-8313

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X Primary
Skilled Nursing Facility 314000000X

Addresses

Primary practice location

445 Tremont St
North Tonawanda, NY 14120-6150

Mailing address

726 Exchange St
Suite 300
Buffalo, NY 14210-1484
Phone (716) 859-7200

Other identifiers 1

IdentifierTypeStateIssuer
00475452MedicaidNY

Other names 1

  • Degraff Memorial SNF Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000038 NY Part A Provider - Skilled Nursing Facility 7810805280 Practice locations: North Tonawanda, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366489221. Details of each certification follow.

Skilled nursing facility certification: CCN 335669

Legal name
KALEIDA HEALTH
Doing business as
DEGRAFF MEMORIAL HOSPITAL-SKILLED NURSING FACILITY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1984
Last certification
Oct 3, 2024
Beds
80
Ownership / control type
Corporation
Multi-facility organization
Kaleida Health
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1998 in NY
Enrollment address
445 Tremont St
North Tonawanda, NY 14120-6150
Nursing home name
DEGRAFF MEMORIAL HOSPITAL-SKILLED NURSING FACILITY

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Degraff Memorial Hospital-Skilled Nursing FacilityCCN 335669 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Apr 1, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8077.0 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Philip Dvoretsky31 organizations share this tax ID, including this one
Part of
Philip Dvoretsky

Other organizations with this tax ID 30

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

View all 30

Locations

414 S Division St
#6
Buffalo, NY 14204

726 Exchange St
Ste 300
Buffalo, NY 14210
Phone (716) 859-8313

Ownership & related parties

All disclosed owners & managing parties 35

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

NameRoleSinceShare
Stephen Hardy Individual Corporate OfficerVP Finance Mar 11, 2019
W-2 Managing EmployeeVP Finance Mar 11, 2019
Prudential Huntoon Paige Associates LTC Isaoa Organization, Dallas, TX Financial institution 5% Or Greater Mortgage Interest Apr 1, 1998 32.61%
Matthew D Drake Individual Corporate OfficerChief Finalcial Officer Dec 5, 2021
W-2 Managing EmployeeChief Financial Officer Dec 5, 2021
Corin Silvestrini Individual W-2 Managing Employee Apr 1, 2024
Mary Lou Rusin Individual Corporate DirectorBoard Member May 1, 2015
Ian Barrett Individual Corporate OfficerChief Human Resource Officer Oct 1, 2022
Jo Ann Ormond Individual W-2 Managing EmployeeDirector Patient Financial Services Aug 19, 2019
Donald Boyd Individual Corporate OfficerPresident, Ceo May 1, 2009
Corporate DirectorBoard Member Jul 11, 2022
Paul O'Leary Individual Corporate DirectorBoard Member Jun 1, 2018
Jennifer Dunn Individual W-2 Managing Employee Apr 1, 2024
Timothy G McEvoy Individual Corporate DirectorBoard Member Jun 1, 2019
Kenneth V Snyder Individual Corporate OfficerChief Physician Quality Officer Apr 1, 2022
Michael P Hughes Individual Corporate OfficerSr VP Chief Administration Officer Sep 1, 2014
Amandeep Pal Individual Contracted Managing EmployeeMD; Apr 1, 2024
K Kent Chevli Individual Corporate DirectorBoard Member Apr 1, 2022
George E Matthews Individual Corporate Director Jun 1, 2008
Shannon Bryant Individual Corporate OfficerChief Diversity & Inclusion Officer Dec 1, 2020
Alyson Spaulding Individual Corporate OfficerGeneral Counsel Aug 1, 2014
Jamie N Nadler Individual Corporate OfficerChief Quality Officer Apr 1, 2022
Thomas Beauford Individual Corporate DirectorBoard Member Apr 1, 2022
Katie Jean Kaus O'Connell Individual W-2 Managing EmployeeVP Revenue Cycle Ops Jun 1, 2018
Christopher D Ross Individual Corporate DirectorBoard Member May 1, 2015
Lorrie Clemo Individual Corporate DirectorBoard Member May 1, 2017
Abeer Eddib Individual Corporate DirectorBoard Member May 1, 2019
Kaleida Health Organization, Buffalo, NY Created for acquisition, Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 1998 100%
Michael J Mineo Individual Corporate OfficerChief Medical Officer Jul 1, 2022
John Persons Individual Corporate DirectorBoard Member Apr 1, 2022
Gary Crosby Individual Corporate DirectorBoard Chair May 1, 2017
Marjorie Quint-Bouzid Individual Corporate OfficerChief Nurse Executive Apr 1, 2024
W-2 Managing Employee Apr 1, 2024
Muhammed Javed Individual Corporate DirectorBoard Member Oct 1, 2019
Nicholas J Aquino Individual Corporate DirectorBoard Member May 1, 2015
Jonathan Hart Individual W-2 Managing EmployeeAd; Apr 1, 2024
Hugh Chisholm Individual Corporate OfficerEvp Cfo Apr 1, 2024
W-2 Managing Employee Apr 1, 2024
William Maggio Individual Corporate DirectorBoard Member May 1, 2015
Angela McCrorey Individual W-2 Managing EmployeeSupervisor Claims PFS Jun 1, 2019

Owners & managing parties with NPI records 16

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 16

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Kaleida HealthBuffalo, NY, CCN 330005 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1998
Kaleida HealthBuffalo, NY, CCN 33T005 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1998
Highpointe on Michigan HCFBuffalo, NY, CCN 335834 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 3, 2011
Visiting Nursing Association of Western New York, Inc.Cheektowaga, NY, CCN 337006 Home health agency 5% Or Greater Direct Ownership Interest Jan 9, 2007

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724284800000",
    "number": "1366489221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "726 EXCHANGE ST",
            "address_2": "SUITE 300",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142101484",
            "telephone_number": "716-859-7200",
            "fax_number": "716-859-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 TREMONT ST",
            "city": "NORTH TONAWANDA",
            "state": "NY",
            "postal_code": "141206150",
            "telephone_number": "716-690-2077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALEIDA HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KALEIDA HEALTH",
        "enumeration_date": "2006-06-01",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A",
        "authorized_official_last_name": "MCCROREY",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "AR MANAGER",
        "authorized_official_telephone_number": "716-859-8313"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00475452",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Degraff Memorial SNF",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Degraff Memorial SNF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Tonawanda, NY

Sources for this page

Verify at the official NPI Registry.