MEDICARE: MARY CARIOLA CHILDREN'S CENTER, INC.

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	6083441	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	:	1306918420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY CARIOLA CHILDREN'S CENTER, INC.

Provider Business Mailing Address
First Line	:	1000 ELMWOOD AVE
Second Line	:	SUITE 100
City	:	ROCHESTER
State	:	NY
Zip	:	14620-3042
Country	:	US
Telephone Number	:	585-271-2897
Fax Number	:	585-442-9985

Provider Business Practice Location Address
First Line	:	2245 ENGLISH RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14616-1651
Country	:	US
Telephone Number	:	585-227-3325
Fax Number	:	585-227-9808

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL C SCOTT
Credential	:	MSW
Telephone Number	:	585-271-2897

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	08/22/2020

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