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General NPI Number Information
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NPI Number | 1295003655
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Entity Type | Organization
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Legal Business Name | PEMBROKE CSD
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 8750 ALLEGHANY RD
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City | CORFU
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State | NY
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Zip | 14036-9702
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Country | US
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Telephone | 585-599-4525
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Fax | 585-599-4213
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Provider Business Mailing Address
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Address Line | 8750 ALLEGHANY RD PO BOX 308
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City | CORFU
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State | NY
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Zip | 14036-9702
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Country | US
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Telephone | 585-599-4525
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Fax | 585-599-4213
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Authorized Official
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Title or Position | SCHOOL ACCOUNTANT
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Name | LINDA GREIG
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Credential |
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Telephone | 585-599-4525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 433545-1
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License Number State | NY
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