Provider Demographics
NPI:1922003144
Name:HORNELL GARDENS, LLC
Entity Type:Organization
Organization Name:HORNELL GARDENS, LLC
Other - Org Name:HORNELL GARDENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHASKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-244-0410
Mailing Address - Street 1:740 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2107
Mailing Address - Country:US
Mailing Address - Phone:585-244-0410
Mailing Address - Fax:585-244-1374
Practice Address - Street 1:434 MONROE AVE
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-2236
Practice Address - Country:US
Practice Address - Phone:607-324-7740
Practice Address - Fax:607-324-4814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5002301314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355913Medicaid
NY00355913Medicaid