Basic Information
| Provider Information | |||||||||
| NPI: | 1932448578 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROCHESTER REGIONAL HEALTH SYSTEM HOME CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 89 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146113201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857237600 | ||||||||
| FaxNumber: | 5853686395 | ||||||||
| Practice Location | |||||||||
| Address1: | 89 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146113201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857237600 | ||||||||
| FaxNumber: | 5853686395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2013 | ||||||||
| LastUpdateDate: | 01/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | BOURNE | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT HOME CARE | ||||||||
| AuthorizedOfficialTelephone: | 5853686454 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PARK RIDGE NURSING HOME, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 03640439 | 05 | NY | MEDICAID |