Provider Demographics
NPI:1477541225
Name:ROCHESTER FRIENDLY HOME
Entity Type:Organization
Organization Name:ROCHESTER FRIENDLY HOME
Other - Org Name:THE FRIENDLY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-218-8869
Mailing Address - Street 1:3156 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3428
Mailing Address - Country:US
Mailing Address - Phone:585-385-0218
Mailing Address - Fax:585-385-0202
Practice Address - Street 1:3156 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3428
Practice Address - Country:US
Practice Address - Phone:585-385-0218
Practice Address - Fax:585-385-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2750301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355582Medicaid
NY00355582Medicaid