Healthcare Provider Details

I. General information

NPI: 1376935957
Provider Name (Legal Business Name): DAYSTAR FORMEDICALLY FRAGILE CHILDREN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAC DE VILLE BLVD
ROCHESTER NY
14618-5665
US

IV. Provider business mailing address

700 LAC DE VILLE BLVD
ROCHESTER NY
14618-5665
US

V. Phone/Fax

Practice location:
  • Phone: 585-385-6287
  • Fax:
Mailing address:
  • Phone: 585-385-6287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DENIQUE CONNER
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 585-385-6287