Healthcare Provider Details

I. General information

NPI: 1477541225
Provider Name (Legal Business Name): ROCHESTER FRIENDLY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 EAST AVE
ROCHESTER NY
14618-3428
US

IV. Provider business mailing address

3156 EAST AVE
ROCHESTER NY
14618-3428
US

V. Phone/Fax

Practice location:
  • Phone: 585-385-0218
  • Fax: 585-385-0202
Mailing address:
  • Phone: 585-385-0218
  • Fax: 585-385-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2750301N
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL PERRY
Title or Position: SR. VP/CFO
Credential:
Phone: 585-218-8869