=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548309214
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SHIRE AT CULVERTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 07/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2515 CULVER RD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14609-1751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-467-4544
-----------------------------------------------------
Fax | 585-338-2877
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2515 CULVER RD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14609-1751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-467-4544
-----------------------------------------------------
Fax | 585-338-2877
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MS. CATHY L REED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 585-467-4544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 9451L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | 370F025
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------