Healthcare Provider Details

I. General information

NPI: 1750735361
Provider Name (Legal Business Name): PARK RIDGE NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 LONG POND RD
ROCHESTER NY
14626-4122
US

IV. Provider business mailing address

1555 LONG POND RD
ROCHESTER NY
14626-4122
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-7260
  • Fax: 585-723-7831
Mailing address:
  • Phone: 585-723-7260
  • Fax: 585-723-7831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number2754302N
License Number StateNY

VIII. Authorized Official

Name: JILL GRAZIANO
Title or Position: VICE-PRESIDENT ELDERONE
Credential:
Phone: 585-922-2808