Healthcare Provider Details

I. General information

NPI: 1679773238
Provider Name (Legal Business Name): FINGER LAKES UNITED CEREBRAL PALSY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 PRE EMPTION RD
GENEVA NY
14456-1335
US

IV. Provider business mailing address

731 PRE EMPTION RD
GENEVA NY
14456-1335
US

V. Phone/Fax

Practice location:
  • Phone: 315-789-6828
  • Fax:
Mailing address:
  • Phone: 315-789-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number010157-1
License Number StateNY

VIII. Authorized Official

Name: REBECCA ANDERSON
Title or Position: DIRECTOR OF OUTPATIENT CLINICAL SER
Credential:
Phone: 585-334-6000