Healthcare Provider Details

I. General information

NPI: 1902272677
Provider Name (Legal Business Name): PERSON CENTERED HOUSING OPTIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 WEST ST
FAIRPORT NY
14450-2109
US

IV. Provider business mailing address

31 WEST ST
FAIRPORT NY
14450-2109
US

V. Phone/Fax

Practice location:
  • Phone: 585-330-6286
  • Fax:
Mailing address:
  • Phone: 585-330-6286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number056719-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number056719-1
License Number StateNY

VIII. Authorized Official

Name: MR. CHARLIE CHRISTOPHER ALBANESE
Title or Position: CEO
Credential: LMSW
Phone: 585-330-6286