MEDICARE: HORNELL GARDENS, LLC

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	314000000X	Skilled Nursing Facility	5002301	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	:	1922003144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORNELL GARDENS, LLC

Provider Business Mailing Address
First Line	:	740 EAST AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-2107
Country	:	US
Telephone Number	:	585-244-0410
Fax Number	:	585-244-1374

Provider Business Practice Location Address
First Line	:	434 MONROE AVE
Second Line	:
City	:	HORNELL
State	:	NY
Zip	:	14843-2236
Country	:	US
Telephone Number	:	607-324-7740
Fax Number	:	607-324-4814

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. BRIDGETT M CHASKO
Credential	:
Telephone Number	:	585-244-0410

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	01/21/2020

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