Provider Demographics
NPI:1700870011
Name:NASCENTIA COMMUNITY CARE
Entity Type:Organization
Organization Name:NASCENTIA COMMUNITY CARE
Other - Org Name:CCH HOME CARE & PALLIATIVE SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-477-9595
Mailing Address - Street 1:1050 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2215
Mailing Address - Country:US
Mailing Address - Phone:315-641-2385
Mailing Address - Fax:
Practice Address - Street 1:1050 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2215
Practice Address - Country:US
Practice Address - Phone:315-641-2385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3301606251E00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3301330ROtherOPERATING CERTIFICATE
NY00396098Medicaid