Healthcare Provider Details

I. General information

NPI: 1518021310
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: 04/26/2016
Certification Date:
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: 315-462-1305
  • Fax: 315-462-3492
Mailing address:
  • Phone: 315-462-9561
  • Fax: 315-462-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number3421000H
License Number StateNY

VIII. Authorized Official

Name: PAULA M TINCH
Title or Position: SVP, FINANCE
Credential:
Phone: 585-922-1223