MEDICARE: LIFESPAN OF GREATER ROCHESTER

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
1	251B00000X	Case Management Agency		NY

Other Identifiers

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

General Provider Information

NPI Number	:	1174951297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESPAN OF GREATER ROCHESTER

Provider Business Mailing Address
First Line	:	1900 CLINTON AVE S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-5621
Country	:	US
Telephone Number	:	585-244-8400
Fax Number	:	585-244-9114

Provider Business Practice Location Address
First Line	:	1900 CLINTON AVE S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-5621
Country	:	US
Telephone Number	:	585-244-8400
Fax Number	:	585-244-9114

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MRS. ANN MARIE COOK
Credential	:
Telephone Number	:	585-244-8400

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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Directions to “LIFESPAN OF GREATER ROCHESTER ” Practice Location

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