Healthcare Provider Details

I. General information

NPI: 1053898783
Provider Name (Legal Business Name): HERITAGE CHRISTIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 KENNETH DR STE 100
ROCHESTER NY
14623-4277
US

IV. Provider business mailing address

275 KENNETH DR STE 100
ROCHESTER NY
14623-4277
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 TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE LABOSSIERE-HALL
Title or Position: ASSOC VP
Credential:
Phone: 585-340-2000