Provider Demographics
NPI:1912895012
Name:ROCHESTER AVON RECREATION AUTHORITY
Entity type:Organization
Organization Name:ROCHESTER AVON RECREATION AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECREATION SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KELSY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:947-886-0084
Mailing Address - Street 1:500 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 E 2ND ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2200
Practice Address - Country:US
Practice Address - Phone:947-886-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp