Provider Demographics
NPI:1033391719
Name:NORTH PARK NURSING HOME
Entity Type:Organization
Organization Name:NORTH PARK NURSING HOME
Other - Org Name:UNITY AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP HOME AND COMMUNITY BASED SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-368-6454
Mailing Address - Street 1:89 GENESEE ST
Mailing Address - Street 2:BISHOP KEARNEY BUILDING
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3201
Mailing Address - Country:US
Mailing Address - Phone:585-368-3440
Mailing Address - Fax:
Practice Address - Street 1:89 GENESEE ST
Practice Address - Street 2:BISHOP KEARNEY BUILDING
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3201
Practice Address - Country:US
Practice Address - Phone:585-368-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH PARK NURSING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-04
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02938690Medicaid