ELDERWOOD OF LAKESIDE AT BROCKPORT
NPI 1245784271
Skilled Nursing Facility in Brockport, NY

Active since August 08, 2016CLIA 33D0654836 · Waiver
4/5
Overall Rating
170 WEST AVE, BROCKPORT, NY 14420(585) 395-6052 Get Directions Write a Review

NPPES record last updated: January 19, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 19, 2023, Jun 14, 2021, Aug 8, 2016 (3 updates tracked since 2016).

About Elderwood Of Lakeside At Brockport NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ELDERWOOD OF LAKESIDE AT BROCKPORT (NPI 1245784271) is a healthcare organization registered as a skilled nursing facility in Brockport, New York and active in the NPI registry since August 2016. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Jeffrey Rubin, Co- Chief Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1245784271
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business Name170 WEST AVENUE OPERATING COMPANY, LLC
Location Address170 WEST AVEBrockport, NY 14420-1227
Mailing Address500 Seneca St Ste 100Buffalo, NY 14204-1963 · (716) 633-3900
Organization SubpartNo
Authorized OfficialJeffrey RubinCo- Chief Executive Officer · (716) 817-5075
Enumeration DateAugust 8, 2016
Last NPPES UpdateJanuary 19, 20233 updates tracked since enumeration
NPPES CertifiedJanuary 19, 2023
NPI 1245784271 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
170 WEST AVE, Brockport, NY 14420

Other Names 1

Doing Business AsElderwood Of Lakeside At Brockport

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D0654836

Elderwood Of Lakeside At Brockport · Brockport, NY
Active · expires Mar 26, 2027
CLIA Number33D0654836
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 1994
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Brian H. Son
Laboratory Phone(585) 395-6052
Laboratory LocationElderwood Of Lakeside At Brockport170 West Ave, Brockport, NY 14420
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Nursing Home Quality Ratings CMS Care Compare

Quality ratings, staffing and inspection history for Elderwood Of Lakeside At Brockport (CMS certification number 335569), from CMS Care Compare.

Elderwood Of Lakeside At Brockport

Nursing home · Brockport, NY
4/5 CMS Overall Rating
OwnershipFor profit - Limited Liability company
CMS Certification Number335569
Certified Beds120 beds105 residents per day on average
Medicare & Medicaid Participant SinceDecember 1, 1976
Resident & Family CouncilResident council
Automatic sprinkler system

CMS Star Ratings

Quality Measures
Based on a select set of clinical quality measures.
2/5
Long-Stay Quality
Quality of care delivered to long-term residents.
2/5
Short-Stay Quality
Quality of care delivered to short-term and rehabilitation residents.
3/5
Staffing
Based on nursing staff hours relative to resident needs.
3/5
Weighted Health Inspection Score
Lower scores are better; the score summarizes deficiencies found on recent inspections.
10.67
Ratings are assigned by CMS on a one-to-five star scale; five is the highest. Categories without a current CMS rating are not shown.

Staffing & Turnover

Total Nurse Staffing
nurse aide 1.65 · LPN 1.14 · RN 0.58
3.37 hrs per resident per day
Weekend Nurse Staffing
2.8 hrs per resident per day
Physical Therapist Staffing
0.12 hrs per resident per day
Nursing Staff Turnover
Share of nursing staff who left the facility within the past year.
48.7%
Registered Nurse Turnover
40.9%
Administrators Who Have Left
In the past year.
0
Higher staffing hours generally allow more direct care time per resident.

Inspections & Enforcement

Facility-Reported Incidents
1
Substantiated Complaints
0
Fines
0
Medicare Payment Denials
0
Total Penalties
0
Counts come from CMS inspections and complaint investigations over approximately the past three years. CMS Care Compare data as of October 1, 2024.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner (Adult Health)
170 WEST AVE
BROCKPORT, NY 14420
Physician Assistant (Medical)
170 WEST AVE
BROCKPORT, NY 14420
Internal Medicine
170 WEST AVE
BROCKPORT, NY 14420
Physical Therapist
170 WEST AVE
BROCKPORT, NY 14420
Skilled Nursing Facility
170 WEST AVE
BROCKPORT, NY 14420

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is 170 West Avenue Operating Company, LLC's NPI number?

The NPI number for 170 West Avenue Operating Company, LLC is 1245784271. It was assigned to this organization in the NPPES registry on August 8, 2016. The provider is doing business as Elderwood Of Lakeside At Brockport.

Where is 170 West Avenue Operating Company, LLC located?

170 West Avenue Operating Company, LLC is located at 170 West Ave, Brockport, NY 14420. The listed phone number is (585) 395-6052.

What is 170 West Avenue Operating Company, LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does 170 West Avenue Operating Company, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D0654836) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is 170 West Avenue Operating Company, LLC a Medicare-certified nursing home?

Yes. Elderwood Of Lakeside At Brockport is a Medicare-certified nursing home with 120 certified beds.

What quality rating does 170 West Avenue Operating Company, LLC have?

CMS rates Elderwood Of Lakeside At Brockport 4 out of 5 stars overall on Care Compare. The full measure detail is in the Nursing Home Quality Ratings section above.

When was this NPI record last updated?

The NPPES record for 170 West Avenue Operating Company, LLC was last updated on January 19, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.