Healthcare Provider Details

I. General information

NPI: 1144557141
Provider Name (Legal Business Name): ELDER ONE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 HUDSON AVE
ROCHESTER NY
14617-4300
US

IV. Provider business mailing address

2066 HUDSON AVE
ROCHESTER NY
14617-4300
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-2800
  • Fax: 585-922-2864
Mailing address:
  • Phone: 585-922-2800
  • Fax: 585-922-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2701907L
License Number StateNY

VIII. Authorized Official

Name: PAULA TINCH
Title or Position: SVP-CFO
Credential:
Phone: 585-922-1233