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General NPI Number Information
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NPI Number | 1023166378
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Entity Type | Organization
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Legal Business Name | PARK RIDGE LIVING CENTER
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 2260 LAKE AVE
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City | ROCHESTER
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State | NY
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Zip | 14612-5758
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Country | US
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Telephone | 585-254-8139
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Fax |
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Provider Business Mailing Address
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Address Line | 2260 LAKE AVE
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City | ROCHESTER
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State | NY
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Zip | 14612-5758
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Country | US
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Telephone | 585-254-8139
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Fax |
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Authorized Official
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Title or Position | VP HOME AND COMMUNITY BASED SERVICE
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Name | SUSAN BOURNE
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Credential |
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Telephone | 585-368-6454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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