Provider Demographics
NPI:1447565759
Name:URMC MEMORY CARE PROGRAM
Entity Type:Organization
Organization Name:URMC MEMORY CARE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR OF FINANCE-URMFG
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HETTERICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-756-4008
Mailing Address - Street 1:315 SCIENCE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4200
Mailing Address - Country:US
Mailing Address - Phone:585-273-5454
Mailing Address - Fax:
Practice Address - Street 1:315 SCIENCE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4200
Practice Address - Country:US
Practice Address - Phone:585-273-5454
Practice Address - Fax:585-341-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03278255Medicaid
NY03278255Medicaid