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General NPI Number Information
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NPI Number | 1437694817
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Entity Type | Organization
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Legal Business Name | CLEMENTS NURSING
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 21 QUAMINA DR
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City | ROCHESTER
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State | NY
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Zip | 14605-1234
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Country | US
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Telephone | 585-410-0365
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Fax |
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Provider Business Mailing Address
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Address Line | 21 QUAMINA DR
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City | ROCHESTER
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State | NY
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Zip | 14605-1234
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Country | US
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Telephone | 585-410-0365
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | ADRIAN DENISE CLEMENTS
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Credential | LPN
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Telephone | 585-410-0365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 258423
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License Number State | NY
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