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General NPI Number Information
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NPI Number | 1134514797
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Entity Type | Organization
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Legal Business Name | HEARTS' OF STARS
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 170 ROXBOROUGH RD
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City | ROCHESTER
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State | NY
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Zip | 14619-1418
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Country | US
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Telephone | 585-967-0206
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Fax |
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Provider Business Mailing Address
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Address Line | 170 ROXBOROUGH RD
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City | ROCHESTER
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State | NY
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Zip | 14619-1418
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Country | US
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Telephone | 585-967-0206
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Fax |
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Authorized Official
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Title or Position | RESIDENTIAL REGISTERED NURSE
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Name | MS. LAURA M MAJOR-ROBERTS
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Credential | REGISTERED NURSE
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Telephone | 585-529-4209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 6455651
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License Number State | NY
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