Provider Demographics
NPI:1255338117
Name:THE CHURCH HOME OF THE PROTESTANT EPISCOPAL CHURCH IN THE CITY OF ROCH
Entity type:Organization
Organization Name:THE CHURCH HOME OF THE PROTESTANT EPISCOPAL CHURCH IN THE CITY OF ROCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARCELLO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:585-546-8400
Mailing Address - Street 1:505 MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2251
Mailing Address - Country:US
Mailing Address - Phone:585-546-8400
Mailing Address - Fax:585-325-6553
Practice Address - Street 1:505 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2251
Practice Address - Country:US
Practice Address - Phone:585-546-8400
Practice Address - Fax:585-325-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2701339N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103363CIOtherPREFERRED CARE - SKILLED
NY3123439OtherAETNA - COMMERCIAL
NY103363XXOtherPREFERRED CARE - CUSTODIA
NY44OtherEXCELLUS BC/BS
NYP014015944OtherBLUE CHOICE THERAPY
NYP015005944OtherBLUE CHOICE ROOM & BOARD
NY103363FQOtherPREFERRED CARE - THERAPY
NY00355500Medicaid
NY335263Medicare Oscar/Certification
81067AMedicare PIN