Healthcare Provider Details

I. General information

NPI: 1700077443
Provider Name (Legal Business Name): HERITAGE CHRISTIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 WEST COMMERCIAL STREET SUITE 2795
EAST ROCHESTER NY
14445
US

IV. Provider business mailing address

349 WEST COMMERCIAL STREET SUITE 2795
EAST ROCHESTER NY
14445
US

V. Phone/Fax

Practice location:
  • Phone: 585-340-2000
  • Fax: 585-340-2006
Mailing address:
  • Phone: 585-340-2000
  • Fax: 585-340-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1901L001
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MARISA GEITNER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 585-340-2000