Provider Demographics
NPI:1003980137
Name:DEPAUL DEVELOPMENTAL SERVICES ATI
Entity Type:Organization
Organization Name:DEPAUL DEVELOPMENTAL SERVICES ATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-426-8000
Mailing Address - Street 1:1931 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1931 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1535
Practice Address - Country:US
Practice Address - Phone:585-426-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02734614Medicaid
NY02004479Medicaid
NY02044008Medicaid
NY01944590Medicaid
NY02725111Medicaid
NY02734554Medicaid
NY02734605Medicaid
NY02593819Medicaid