Healthcare Provider Details

I. General information

NPI: 1841656469
Provider Name (Legal Business Name): LATTA ROAD NURSING HOME WEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LATTA RD
ROCHESTER NY
14612-3728
US

IV. Provider business mailing address

740 EAST AVE
ROCHESTER NY
14607-2107
US

V. Phone/Fax

Practice location:
  • Phone: 585-255-0910
  • Fax: 585-225-5126
Mailing address:
  • Phone: 585-244-0410
  • Fax: 585-244-1374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BRIDGETT REED
Title or Position: CFO
Credential:
Phone: 585-244-0410