Provider Demographics
NPI:1255482535
Name:PRCD, INC.
Entity Type:Organization
Organization Name:PRCD, INC.
Other - Org Name:ADOLESCENT COMMUNITY RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT HEALTH CARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-723-7185
Mailing Address - Street 1:2654 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4209
Mailing Address - Country:US
Mailing Address - Phone:585-723-7350
Mailing Address - Fax:585-723-7353
Practice Address - Street 1:2654 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4209
Practice Address - Country:US
Practice Address - Phone:585-723-7350
Practice Address - Fax:585-723-7353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02754676Medicaid