Provider Demographics
NPI:1164061628
Name:IBERO AMERICAN ACTION LUEAGE, INC.
Entity Type:Organization
Organization Name:IBERO AMERICAN ACTION LUEAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HCBS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GRISELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CASAC- T
Authorized Official - Phone:585-256-8900
Mailing Address - Street 1:817 EAST MAIN STREET
Mailing Address - Street 2:SAME
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-5144
Mailing Address - Country:US
Mailing Address - Phone:585-256-8900
Mailing Address - Fax:585-544-8608
Practice Address - Street 1:817 EAST MAIN STREET
Practice Address - Street 2:SAME
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-5144
Practice Address - Country:US
Practice Address - Phone:585-256-8900
Practice Address - Fax:585-544-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No385H00000XRespite Care FacilityRespite Care