Provider Demographics
NPI:1225067168
Name:ST. ANN'S HOME FOR THE AGED
Entity Type:Organization
Organization Name:ST. ANN'S HOME FOR THE AGED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-697-6307
Mailing Address - Street 1:1500 PORTLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-697-6337
Mailing Address - Fax:585-544-4226
Practice Address - Street 1:1500 PORTLAND AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-697-6337
Practice Address - Fax:585-544-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
NY2757300N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02994787Medicaid
NY353806Medicaid
NY02994787Medicaid
NY81040AMedicare PIN
81040AMedicare PIN