Provider Demographics
NPI:1740216050
Name:ST. ANN'S NURSING HOME COMPANY, INC
Entity type:Organization
Organization Name:ST. ANN'S NURSING HOME COMPANY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-697-6307
Mailing Address - Street 1:1500 PORTLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-697-6337
Mailing Address - Fax:585-544-4226
Practice Address - Street 1:920 CHERRY RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-4801
Practice Address - Country:US
Practice Address - Phone:585-697-6337
Practice Address - Fax:585-544-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2757301N314000000X
NY314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY353815Medicaid
NY353815Medicaid
NY81041AMedicare PIN