Healthcare Provider Details

I. General information

NPI: 1548705387
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE DIOCESE OF ROCHESTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E UNION ST
NEWARK NY
14513-1609
US

IV. Provider business mailing address

407 E UNION ST
NEWARK NY
14513-1609
US

V. Phone/Fax

Practice location:
  • Phone: 315-331-2300
  • Fax: 315-331-2301
Mailing address:
  • Phone: 315-331-2300
  • Fax: 315-331-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN JOHNSON
Title or Position: CFO
Credential:
Phone: 585-546-7220