Healthcare Provider Details

I. General information

NPI: 1306089784
Provider Name (Legal Business Name): ROCHESTER FRIENDLY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 EAST AVE
ROCHESTER NY
14618-3428
US

IV. Provider business mailing address

3156 EAST AVE
ROCHESTER NY
14618-3428
US

V. Phone/Fax

Practice location:
  • Phone: 585-381-1600
  • Fax:
Mailing address:
  • Phone: 585-381-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINE A JOHNSON
Title or Position: CFO
Credential: CPA
Phone: 585-789-3211