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General NPI Number Information
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NPI Number | 1134597685
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Entity Type | Organization
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Legal Business Name | TAHJA EASON
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 70 LAKESHIRE RD
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City | ROCHESTER
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State | NY
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Zip | 14612-5222
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Country | US
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Telephone | 585-734-5436
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Fax |
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Provider Business Mailing Address
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Address Line | 70 LAKESHIRE RD
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City | ROCHESTER
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State | NY
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Zip | 14612-5222
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Country | US
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Telephone | 585-734-5436
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MS. TAHJA M EASON
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Credential |
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Telephone | 585-734-5436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 313387
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License Number State | NY
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