Healthcare Provider Details

I. General information

NPI: 1851367486
Provider Name (Legal Business Name): GRHS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 LINDEN OAKS DRIVE
ROCHESTER NY
14625-2814
US

IV. Provider business mailing address

360 LINDEN OAKS DRIVE
ROCHESTER NY
14625-2814
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-6200
  • Fax: 585-922-6262
Mailing address:
  • Phone: 585-922-6200
  • Fax: 585-922-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2701229R
License Number StateNY

VIII. Authorized Official

Name: JEFF PEACOCK
Title or Position: EXEC DIRECTOR
Credential:
Phone: 585-922-6201