Healthcare Provider Details

I. General information

NPI: 1982775441
Provider Name (Legal Business Name): 34HOME NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 WEST LAKE ROAD
CANANDAIGUA NY
14424
US

IV. Provider business mailing address

638 YALE FARM RD
ROMULUS NY
14541-9718
US

V. Phone/Fax

Practice location:
  • Phone: 585-396-2001
  • Fax:
Mailing address:
  • Phone: 315-585-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number124749-1
License Number StateNY

VIII. Authorized Official

Name: CAROLYN A BERRY
Title or Position: LPN
Credential:
Phone: 315-585-4445