Provider Demographics
NPI:1568534055
Name:DEPAUL ADULT CARE
Entity Type:Organization
Organization Name:DEPAUL ADULT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-426-8000
Mailing Address - Street 1:1931 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1535
Mailing Address - Country:US
Mailing Address - Phone:585-464-8870
Mailing Address - Fax:585-464-8077
Practice Address - Street 1:1931 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1535
Practice Address - Country:US
Practice Address - Phone:585-464-8870
Practice Address - Fax:585-464-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL034028310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803856Medicaid
NC7803342Medicaid
NC7803854Medicaid
NC7806489Medicaid
NC7805958Medicaid
NC7803857Medicaid
NC7804726Medicaid
NC7803053Medicaid
NC7805636Medicaid
NC7806490Medicaid
NC7803855Medicaid
NC7805425Medicaid
NC7805959Medicaid