Healthcare Provider Details

I. General information

NPI: 1780941948
Provider Name (Legal Business Name): NURSING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 LAFORCE STREET
ROCHESTER NY
14621
US

IV. Provider business mailing address

33 LAFORCE ST
ROCHESTER NY
14621-4509
US

V. Phone/Fax

Practice location:
  • Phone: 585-406-2422
  • Fax:
Mailing address:
  • Phone: 585-406-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number307327
License Number StateNY

VIII. Authorized Official

Name: ROSE ENIDE GESNER
Title or Position: LPN
Credential:
Phone: 585-406-2422