Provider Demographics
NPI:1295165744
Name:ELLEN CARRION
Entity type:Organization
Organization Name:ELLEN CARRION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CARRION
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:585-729-6334
Mailing Address - Street 1:22 JENNIE LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-5814
Mailing Address - Country:US
Mailing Address - Phone:585-729-6334
Mailing Address - Fax:
Practice Address - Street 1:22 JENNIE LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5814
Practice Address - Country:US
Practice Address - Phone:585-729-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274830311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336376839OtherNPI