Provider Demographics
NPI:1417171562
Name:EAST HOUSE CORP
Entity Type:Organization
Organization Name:EAST HOUSE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-238-4823
Mailing Address - Street 1:259 MONROE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-3632
Mailing Address - Country:US
Mailing Address - Phone:585-238-4800
Mailing Address - Fax:585-238-4899
Practice Address - Street 1:259 MONROE AVE., STE. 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-5630
Practice Address - Country:US
Practice Address - Phone:585-238-4800
Practice Address - Fax:585-238-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6081438320800000X
NY6081430320800000X
NY6081441320800000X
NY6081440320800000X
NY6081437320800000X
NY6081436320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01303662Medicaid