Healthcare Provider Details

I. General information

NPI: 1366505463
Provider Name (Legal Business Name): CLIFTON SPRINGS SANITARIUM CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COULTER RD
CLIFTON SPRINGS NY
14432-1122
US

IV. Provider business mailing address

100 KINGS HIGHWAY SOUTH
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 315-462-9561
  • Fax: 315-462-3492
Mailing address:
  • Phone: 315-462-9561
  • Fax: 315-462-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number3421000H
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA J PATTON
Title or Position: MANAGER PROVIDER ENROLLMENT
Credential: RN, BSN
Phone: 585-922-0527