Provider Demographics
NPI:1578640298
Name:VILLA OF HOPE
Entity Type:Organization
Organization Name:VILLA OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GULLO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, MBA
Authorized Official - Phone:585-865-1550
Mailing Address - Street 1:3300 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-3741
Mailing Address - Country:US
Mailing Address - Phone:585-865-1550
Mailing Address - Fax:585-865-5219
Practice Address - Street 1:3300 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-3741
Practice Address - Country:US
Practice Address - Phone:585-865-1550
Practice Address - Fax:585-865-5219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01408057Medicaid
NY01980978Medicaid
NY00353571Medicaid
NY02909795Medicaid
NY00031057901OtherUNIVERA - EATING DISORDER
NY00832040Medicaid
NY02458097Medicaid
NYP012005941OtherEXCELLUS EATING DISORDER
NYP014005952OtherEXCELLUS CD CLINIC