Healthcare Provider Details

I. General information

NPI: 1699824847
Provider Name (Legal Business Name): NORTH PARK NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ISLAND COTTAGE RD
ROCHESTER NY
14612-2312
US

IV. Provider business mailing address

700 ISLAND COTTAGE RD
ROCHESTER NY
14612-2312
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-6130
  • Fax: 585-368-6030
Mailing address:
  • Phone: 585-368-6130
  • Fax: 585-368-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA TEUGEMAN
Title or Position: ADMINISTRATOR, NHA
Credential:
Phone: 585-368-6105