1306832613 NPI number — GENESEE VALLEY PRESBYTERIAN NURSING CENTER

Table of content: (NPI 1306832613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306832613 NPI number — GENESEE VALLEY PRESBYTERIAN NURSING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESEE VALLEY PRESBYTERIAN NURSING CENTER
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:
KIRKHAVEN
Provider Other Organization Name Type Code:
3
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:
1306832613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
254 ALEXANDER ST
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:
14607-2515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-461-1991
Provider Business Mailing Address Fax Number:
585-461-9833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
254 ALEXANDER ST
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:
14607-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-461-1991
Provider Business Practice Location Address Fax Number:
585-461-9833
Provider Enumeration Date:
09/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
EXECUTIVE VP/ADMINISTRATOR
Authorized Official Telephone Number:
585-461-1991

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2701345N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04-21-65 . This is a "NY STATE REG. NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00817189 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1212440001 . This is a "DMERC NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3164 . This is a "NYS PFI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2701345N . This is a "OPERATING CERTIFICATE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 164047 . This is a "NYS TAX EXEMPT NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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