Provider Demographics
NPI:1699824847
Name:NORTH PARK NURSING HOME
Entity Type:Organization
Organization Name:NORTH PARK NURSING HOME
Other - Org Name:NORTH PARK NH ADHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR, NHA
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEUGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-368-6105
Mailing Address - Street 1:700 ISLAND COTTAGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-2312
Mailing Address - Country:US
Mailing Address - Phone:585-368-6130
Mailing Address - Fax:585-368-6030
Practice Address - Street 1:700 ISLAND COTTAGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-2312
Practice Address - Country:US
Practice Address - Phone:585-368-6130
Practice Address - Fax:585-368-6030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH PARK NURSING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-09
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01535840Medicaid