Healthcare Provider Details

I. General information

NPI: 1508250267
Provider Name (Legal Business Name): DAYSTAR FOR MEDICALLY FRAGILE CHILDREN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAC DE VILLE BLVD
ROCHESTER NY
14618
US

IV. Provider business mailing address

700 LAC DE VILLE BLVD
ROCHESTER NY
14618
US

V. Phone/Fax

Practice location:
  • Phone: 585-385-6287
  • Fax: 585-383-0033
Mailing address:
  • Phone: 585-385-6287
  • Fax: 585-383-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIM CONDON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 585-385-6287