1033541107 NPI number — THE COMMUNITY PLACE OF GREATER ROCHESTER, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033541107 NPI number — THE COMMUNITY PLACE OF GREATER ROCHESTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE COMMUNITY PLACE OF GREATER ROCHESTER, 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:
1033541107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 CENTRAL PARK
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:
14605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-327-7200
Provider Business Mailing Address Fax Number:
585-423-7440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 CARTER STREET
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:
14621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-336-4688
Provider Business Practice Location Address Fax Number:
585-336-6704
Provider Enumeration Date:
07/31/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIN
Authorized Official First Name:
SUE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
585-327-7200

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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