Provider Demographics
NPI:1770867988
Name:ST. JOHN'S PENFIELD HOMES CORPORATION
Entity Type:Organization
Organization Name:ST. JOHN'S PENFIELD HOMES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:K
Authorized Official - Last Name:RUNYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-760-1202
Mailing Address - Street 1:150 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3024
Mailing Address - Country:US
Mailing Address - Phone:585-760-1300
Mailing Address - Fax:
Practice Address - Street 1:65 & 75 SONOMA DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-2105
Practice Address - Country:US
Practice Address - Phone:585-760-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility