Provider Demographics
NPI:1356348874
Name:CREST MANOR LIVING AND REHABILITATION CENTER INC
Entity type:Organization
Organization Name:CREST MANOR LIVING AND REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BARTHOLOMEW
Authorized Official - Suffix:SR
Authorized Official - Credentials:LNHA
Authorized Official - Phone:585-223-3633
Mailing Address - Street 1:6745 PITTSFORD PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3343
Mailing Address - Country:US
Mailing Address - Phone:585-223-3633
Mailing Address - Fax:585-425-2961
Practice Address - Street 1:6745 PITTSFORD PALMYRA RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3343
Practice Address - Country:US
Practice Address - Phone:585-223-3633
Practice Address - Fax:585-425-2961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2762301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCMOtherEXCELLUS
NY00355519Medicaid
NYP015005983OtherBLUE CHOICE
NY106012CIOtherPREF. CARE
NYP015005983OtherBLUE CHOICE