Healthcare Provider Details

I. General information

NPI: 1639614472
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE DIOCESE OF ROCHESTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 SAINT PAUL ST
ROCHESTER NY
14605-1051
US

IV. Provider business mailing address

997 SAINT PAUL ST
ROCHESTER NY
14605-1051
US

V. Phone/Fax

Practice location:
  • Phone: 585-266-3080
  • Fax: 585-266-0214
Mailing address:
  • Phone: 585-266-3080
  • Fax: 585-266-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN JOHNSON
Title or Position: CFO
Credential:
Phone: 585-546-7220