Provider Demographics
NPI:1306832613
Name:GENESEE VALLEY PRESBYTERIAN NURSING CENTER
Entity Type:Organization
Organization Name:GENESEE VALLEY PRESBYTERIAN NURSING CENTER
Other - Org Name:KIRKHAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-461-1991
Mailing Address - Street 1:254 ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2515
Mailing Address - Country:US
Mailing Address - Phone:585-461-1991
Mailing Address - Fax:585-461-9833
Practice Address - Street 1:254 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2515
Practice Address - Country:US
Practice Address - Phone:585-461-1991
Practice Address - Fax:585-461-9833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2701345N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04-21-65OtherNY STATE REG. NUMBER
NY00817189Medicaid
NY1212440001OtherDMERC NUMBER
NY3164OtherNYS PFI
NY2701345NOtherOPERATING CERTIFICATE
NY164047OtherNYS TAX EXEMPT NUMBER
NYB75012Medicare UPIN
NYE16829Medicare UPIN
NY1212440001OtherDMERC NUMBER
NY04-21-65OtherNY STATE REG. NUMBER