Provider Demographics
NPI:1265504385
Name:MARY CARIOLA CHILDREN'S CENTER, INC.
Entity Type:Organization
Organization Name:MARY CARIOLA CHILDREN'S CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:585-271-2897
Mailing Address - Street 1:1000 ELMWOOD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3042
Mailing Address - Country:US
Mailing Address - Phone:585-271-2897
Mailing Address - Fax:585-442-9985
Practice Address - Street 1:6239 PITTSFORD PALMYRA RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3123
Practice Address - Country:US
Practice Address - Phone:585-223-7847
Practice Address - Fax:585-223-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6083443315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00855990Medicaid