Provider Demographics
NPI:1265596019
Name:GENESEE VALLEY GROUP HEALTH ASSOCIATION
Entity type:Organization
Organization Name:GENESEE VALLEY GROUP HEALTH ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLASCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-336-4841
Mailing Address - Street 1:800 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:535 SUMMIT POINT DR
Practice Address - Street 2:SUITE #3
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9606
Practice Address - Country:US
Practice Address - Phone:585-324-9662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESEE VALLEY GROUP HEALTH ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-19
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0246233336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP0170059LHOtherHOME INFUSION SUPPLIER #
NY3311937OtherINFUSION PHARMACY
NY02058611Medicaid
NYP0170059LHOtherHOME INFUSION SUPPLIER #