Healthcare Provider Details

I. General information

NPI: 1841534682
Provider Name (Legal Business Name): FAMILY FIRST NEW YORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2012
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N CHESTNUT ST
ROCHESTER NY
14604-1441
US

IV. Provider business mailing address

111 N CHESTNUT ST
ROCHESTER NY
14604-1441
US

V. Phone/Fax

Practice location:
  • Phone: 585-802-2495
  • Fax:
Mailing address:
  • Phone: 585-802-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number8606365
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number8606365
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number8606365
License Number StateNY

VIII. Authorized Official

Name: MRS. TINA MARIE RICKS
Title or Position: VICE PRESIDENT
Credential:
Phone: 585-317-9230