Fairchild Manor Nursing Home LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

3121302N Issued in NY

Legal business name

FAIRCHILD MANOR NURSING HOME LLC

Practice address

765 Fairchild PL
Lewiston, NY 14092-1309

Phone

(716) 634-7600

Fax

(716) 633-3369

NPI assigned

Sep 23, 2005

Last updated

Nov 30, 2017By 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

Mr. Marc I Korn

Title

President Owner

Phone

(716) 867-4853

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512000000000",
    "number": "1528054657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "POST OFFICE BOX 0730",
            "city": "EAST AMHERST",
            "state": "NY",
            "postal_code": "140510730",
            "telephone_number": "716-867-4853",
            "fax_number": "716-633-3369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 FAIRCHILD PL",
            "city": "LEWISTON",
            "state": "NY",
            "postal_code": "140921309",
            "telephone_number": "716-634-7600",
            "fax_number": "716-633-3369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRCHILD MANOR NURSING HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-23",
        "last_updated": "2017-11-30",
        "status": "A",
        "authorized_official_last_name": "KORN",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "716-867-4853",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "3121302N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02099296",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy George Dyster, M.D.
• Jake Eberth, DC (CHIROPRACTIC)
• Andrea Nicole Edwards, LPN
• Samir El-Chehabi, DDS
• Exigence Hospitalist Medical Services of Lewiston, PLLC
• Donna Azam Feldman, MD
• Philip Rhoney Fending, MD
• Shawn P Ferguson, M.D.
• Peter Ferin, M.D.
• Sean Fetzer

• Skilled Nursing Facility in Lewiston, NY
• Providers in Lewiston, 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 Nov 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.