1568534055 NPI number — DEPAUL ADULT CARE

Table of content: (NPI 1568534055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568534055 NPI number — DEPAUL ADULT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPAUL ADULT CARE
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:
1568534055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1931 BUFFALO RD
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:
585-464-8870
Provider Business Mailing Address Fax Number:
585-464-8077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1931 BUFFALO RD
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:
14624-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-464-8870
Provider Business Practice Location Address Fax Number:
585-464-8077
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:
585-426-8000

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  HAL034028 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7803856 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7803342 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7803854 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7806489 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7805958 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7803857 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7804726 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7803053 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7805636 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7806490 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7803855 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7805425 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7805959 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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