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NPI Code Detail

MEDICARE: INDEPENDENT LIVING FOR SENIORS - FEE FOR SERVICE

MEDICARE: INDEPENDENT LIVING FOR SENIORS - FEE FOR SERVICE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1302R00000XHealth Maintenance Organization

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093935967
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDEPENDENT LIVING FOR SENIORS - FEE FOR SERVICE
Provider Business Mailing Address
First Line : 2066 HUDSON AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14617-4300
Country : US
Telephone Number : 585-922-2800
Fax Number :
Provider Business Practice Location Address
First Line : 2066 HUDSON AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14617-4300
Country : US
Telephone Number : 585-922-2800
Fax Number :
Authorized Official
Title or Position : VP-PATIENT FINANCIAL SERVICES
Name : MR. JOHN P MIDOLO
Credential :
Telephone Number : 585-922-1958
Provider Enumeration Date : 04/26/2007
Last Update Date : 08/22/2020

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Directions to “INDEPENDENT LIVING FOR SENIORS - FEE FOR SERVICE ” Practice Location

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