Healthcare Provider Details

I. General information

NPI: 1255338117
Provider Name (Legal Business Name): THE CHURCH HOME OF THE PROTESTANT EPISCOPAL CHURCH IN THE CITY OF ROCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 MOUNT HOPE AVE
ROCHESTER NY
14620-2251
US

IV. Provider business mailing address

505 MOUNT HOPE AVE
ROCHESTER NY
14620-2251
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-8400
  • Fax: 585-325-6553
Mailing address:
  • Phone: 585-546-8400
  • Fax: 585-325-6553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2701339N
License Number StateNY

VIII. Authorized Official

Name: MS. LISA J MARCELLO
Title or Position: EXECUTIVE VP/CFO
Credential: CPA
Phone: 585-546-8400