Healthcare Provider Details

I. General information

NPI: 1306918420
Provider Name (Legal Business Name): MARY CARIOLA CHILDREN'S CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 ENGLISH RD
ROCHESTER NY
14616-1651
US

IV. Provider business mailing address

1000 ELMWOOD AVE SUITE 100
ROCHESTER NY
14620-3042
US

V. Phone/Fax

Practice location:
  • Phone: 585-227-3325
  • Fax: 585-227-9808
Mailing address:
  • Phone: 585-271-2897
  • Fax: 585-442-9985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number6083441
License Number StateNY

VIII. Authorized Official

Name: MR. PAUL C SCOTT
Title or Position: PRESIDENT
Credential: MSW
Phone: 585-271-2897