Basic Information
| Provider Information | |||||||||
| NPI: | 1508188798 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCHOOL OF THE HOLY CHILDHOOD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 GROTON PKWY | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146234540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853593710 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 GROTON PKWY | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146234540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853593710 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2010 | ||||||||
| LastUpdateDate: | 02/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | GALBIER | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5853593710 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 004353-1 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | 00357240 | 01 | NY | MMIS | OTHER |