1780756114 NPI number — DEPAUL COMMUNITY SERVICES INC

Table of content: (NPI 1780756114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780756114 NPI number — DEPAUL COMMUNITY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPAUL COMMUNITY SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780756114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1931 BUFFALO ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14624-1535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-426-8000
Provider Business Mailing Address Fax Number:
585-719-3183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 MT. HOPE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14620-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-426-8000
Provider Business Practice Location Address Fax Number:
585-429-5211
Provider Enumeration Date:
11/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WHALEN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
585-719-3170

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00357557 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".