NPIMap

Organization Active NPI

Newark Manor Nursing Home, Inc.

  • Skilled Nursing Facility
  • Newark, NY
National Provider Identifier
1407851629
Registry record updated Sep 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
5820301 Issued in NY
Legal business name
NEWARK MANOR NURSING HOME, INC.
Practice address
222 W Pearl St
Newark, NY 14513-1048
Phone
(315) 331-4690
Fax
(315) 331-8947
NPI assigned
Jun 15, 2005
Last updated
Sep 24, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2015

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

Authorized official

Name
Mr. Robert W Hurlbut
Title
Owner/President
Phone
(585) 244-0410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 5820301 NY Primary

Addresses

Primary practice location

222 W Pearl St
Newark, NY 14513-1048

Mailing address

740 East Ave
Rochester, NY 14607-2107
Phone (585) 244-0410

Other identifiers 1

IdentifierTypeStateIssuer
00355697MedicaidNY

Other names 1

  • Newark Manor Nursing Home Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040727000138 NY Part A Provider - Skilled Nursing Facility 2264402536 Practice locations: Newark, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407851629. Details of each certification follow.

Skilled nursing facility certification: CCN 335219001

Legal name
NEWARK MANOR NURSING HOME, INC.
Doing business as
NEWARK MANOR NURSING HOME
Organization structure
CorporationProprietary
Incorporated
Jul 1, 1997 in NY
Enrollment address
222 W Pearl St
Newark, NY 14513-1048
Nursing home name
NEWARK MANOR NURSING HOME INC
Affiliated entity
HURLBUT CARE

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0172109Newark Manor Nursing Home Inc222 W Pearl Street, Newark, NY 14513Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

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.

NameRoleSinceShare
Hurlbut Health Consulting, LLC Organization, Rochester, NY LLC Operational/Managerial Control Jan 1, 2020 100%
Robert W Hurlbut Individual 5% Or Greater Direct Ownership InterestPresident/Ceo Jul 1, 1997 100%
Mark Curletta Individual Corporate OfficerVice President Jul 16, 2021
W-2 Managing EmployeeVice President Jul 16, 2021
Operational/Managerial ControlVice President Jul 16, 2021

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443052800000",
    "number": "1407851629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 EAST AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146072107",
            "telephone_number": "585-244-0410",
            "fax_number": "585-244-1208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W PEARL ST",
            "city": "NEWARK",
            "state": "NY",
            "postal_code": "145131048",
            "telephone_number": "315-331-4690",
            "fax_number": "315-331-8947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWARK MANOR NURSING HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-15",
        "last_updated": "2015-09-24",
        "status": "A",
        "authorized_official_last_name": "HURLBUT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "585-244-0410",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "5820301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00355697",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Newark Manor Nursing Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Newark, NY

Sources for this page

Verify at the official NPI Registry.