Provider Demographics
NPI:1639614472
Name:CATHOLIC CHARITIES OF THE DIOCESE OF ROCHESTER
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE OF ROCHESTER
Other - Org Name:CATHOLIC FAMILY CENTER RESTART LIBERTY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-546-7220
Mailing Address - Street 1:997 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-1051
Mailing Address - Country:US
Mailing Address - Phone:585-266-3080
Mailing Address - Fax:585-266-0214
Practice Address - Street 1:997 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-1051
Practice Address - Country:US
Practice Address - Phone:585-266-3080
Practice Address - Fax:585-266-0214
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF DIOCESE OF ROCHESTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-04
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY171212060OtherNYS OASAS